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General NPI Number Information
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NPI Number | 1750796025
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Entity Type | Organization
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Legal Business Name | GRANDPARENTS CLUB ADULT DAY CARE, LLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 4729 NW 183 STREET
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City | MIAMI
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State | FL
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Zip | 33055
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Country | US
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Telephone | 786-916-5306
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Fax | 786-916-5307
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Provider Business Mailing Address
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Address Line | 4729 NW 183 STREET
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City | MIAMI
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State | FL
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Zip | 33055
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Country | US
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Telephone | 786-916-5306
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Fax | 786-916-5307
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA LYNN NAVA
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Credential |
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Telephone | 305-890-1371
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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 | FL
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