MEDICARE: AZUCAR ADULT DAY CARE

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	9235	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9235	OTHER	FL	AGENCY FOR HEALTH CARE ADMINISTRATION- DIVISION OF HEALTH QUALITY ASSURANCE

General Provider Information

NPI Number	:	1396088936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZUCAR ADULT DAY CARE

Provider Business Mailing Address
First Line	:	8655 SW 24TH ST
Second Line	:	SUITE C
City	:	MIAMI
State	:	FL
Zip	:	33155-2337
Country	:	US
Telephone Number	:	305-815-8367
Fax Number	:	305-748-2544

Provider Business Practice Location Address
First Line	:	8655 SW 24TH ST
Second Line	:	SUITE C
City	:	MIAMI
State	:	FL
Zip	:	33155-2337
Country	:	US
Telephone Number	:	305-815-8367
Fax Number	:	305-748-2544

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LISSETTE GANCEDO
Credential	:
Telephone Number	:	305-815-8367

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/02/2013

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Directions to “AZUCAR ADULT DAY CARE ” Practice Location

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