=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821427642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE ADULT DAY CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2013
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 LINDSAY CT SUITE 101-106
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-900-0090
-----------------------------------------------------
Fax | 786-900-0094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 LINDSAY CT SUITE 101-106
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-900-0090
-----------------------------------------------------
Fax | 786-900-0094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MAILYN FERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-715-6657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 9262
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------