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General NPI Number Information
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NPI Number | 1891118766
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Entity Type | Organization
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Legal Business Name | SAN JUDAS HOME CARE CORP
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 10720 NW 5TH AVE
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City | MIAMI
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State | FL
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Zip | 33168-3209
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Country | US
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Telephone | 305-762-4064
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Fax |
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Provider Business Mailing Address
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Address Line | 10720 NW 5TH AVE
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City | MIAMI
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State | FL
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Zip | 33168-3209
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Country | US
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Telephone | 305-762-4064
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GRECIA PURI
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Credential |
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Telephone | 305-762-4064
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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 | 10118
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License Number State | FL
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