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General NPI Number Information
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NPI Number | 1649693730
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Entity Type | Organization
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Legal Business Name | AGING CARE CENTER INC
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE 104
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2458
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Country | US
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Telephone | 305-698-8628
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Fax | 305-698-8629
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Provider Business Mailing Address
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Address Line | 15291 NW 60TH AVE 104
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2458
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Country | US
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Telephone | 305-698-8628
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Fax | 305-698-8629
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TAMARA RODRIGUEZ
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Credential |
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Telephone | 305-389-4214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1212604260
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License Number State | FL
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