=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639889553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAPPY PLACE ADC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2022
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2665 CLEVELAND AVE STE 105&107
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-323-4441
-----------------------------------------------------
Fax | 239-306-7534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2665 CLEVELAND AVE STE 105&107
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-323-4441
-----------------------------------------------------
Fax | 239-306-7534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAMILO RODRIGUEZ GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-774-6505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------