MEDICARE: PENATE ADULT DAYCARE 4 LLC

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	261QA0600X	Adult Day Care Clinic/Center

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

General Provider Information

NPI Number	:	1336720150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENATE ADULT DAYCARE 4 LLC

Provider Business Mailing Address
First Line	:	4847 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	786-725-3822
Fax Number	:	786-577-5253

Provider Business Practice Location Address
First Line	:	4847 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	786-725-3822
Fax Number	:	786-577-5253

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLARA PENATE
Credential	:
Telephone Number	:	786-725-3822

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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Directions to “PENATE ADULT DAYCARE 4 LLC ” Practice Location

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