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General NPI Number Information
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NPI Number | 1609272913
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Entity Type | Organization
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Legal Business Name | MEMORIES ADULT DAY CARE CENTER, LLC.
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 124 W 13TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-6844
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Country | US
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Telephone | 561-598-0786
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Fax |
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Provider Business Mailing Address
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Address Line | 124 W 13TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-6844
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Country | US
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Telephone | 561-598-0786
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GLADYS D. WHITE-JOHNSON
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Credential |
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Telephone | 561-598-0786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12563
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License Number State | FL
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