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General NPI Number Information
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NPI Number | 1700922416
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Entity Type | Organization
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Legal Business Name | SAN JUDAS TADEO COMMUNITY ADULT DAY CARE CORP
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 15628 SW 72 STREET
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City | MIAMI
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State | FL
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Zip | 33193
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Country | US
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Telephone | 305-408-0077
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Fax | 305-408-7737
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Provider Business Mailing Address
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Address Line | 15628 SW 72 STREET
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City | MIAMI
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State | FL
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Zip | 33193
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Country | US
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Telephone | 305-408-0077
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Fax | 305-408-7737
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA DAVALOS
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Credential |
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Telephone | 305-408-0077
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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 | 9034
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License Number State | FL
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