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General NPI Number Information
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NPI Number | 1649586454
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Entity Type | Organization
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Legal Business Name | MESA ADULT CARE CORP
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 2668 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6314
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Country | US
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Telephone | 305-220-1887
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Fax | 305-220-1881
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Provider Business Mailing Address
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Address Line | 2668 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6314
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Country | US
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Telephone | 305-307-6965
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Fax | 305-220-1881
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JULIAN MESA
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Credential |
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Telephone | 305-307-6965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9146
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License Number State | FL
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