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General NPI Number Information
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NPI Number | 1699417741
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Entity Type | Organization
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Legal Business Name | SUPREME ADULT DAY CARE, INC
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 8250 W 21ST LN STE 100
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City | HIALEAH
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State | FL
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Zip | 33016-1908
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Country | US
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Telephone | 305-846-9345
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Fax | 305-392-0316
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Provider Business Mailing Address
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Address Line | 8250 W 21ST LN STE 100
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City | HIALEAH
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State | FL
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Zip | 33016-1908
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Country | US
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Telephone | 305-846-9345
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Fax | 305-392-0316
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIVIAN FLEITAS
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Credential |
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Telephone | 305-846-9345
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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 |
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License Number State |
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