MEDICARE: EMILY C MOISES DAY TRAINING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center	687612998	FL
2	347C00000X	Private Vehicle	687612998	FL
3	347C00000X	Private Vehicle	687612996	FL
4	261QD1600X	Developmental Disabilities Clinic/Center	687612996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083906259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY C MOISES DAY TRAINING CENTER

Provider Business Mailing Address
First Line	:	5643 NW 36TH ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5854
Country	:	US
Telephone Number	:	305-888-8711
Fax Number	:	305-888-4947

Provider Business Practice Location Address
First Line	:	5643 NW 36TH ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5854
Country	:	US
Telephone Number	:	305-888-8711
Fax Number	:	305-888-4947

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NIEVES MOISES
Credential	:	MSW
Telephone Number	:	305-888-8711

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	05/06/2011

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