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General NPI Number Information
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NPI Number | 1760792071
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Entity Type | Organization
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Legal Business Name | CORAL WEST ADULT DAY CARE CENTER
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 2370 SW 67 AVE BLDG B
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-216-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 SW 67 AVE BLDG B
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-216-4434
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | JACINTO ABDALA
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Credential |
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Telephone | 305-216-4434
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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 | 9151
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License Number State | FL
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