MEDICARE: PROMISE HEALTH CORP

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

General Provider Information

NPI Number	:	1407608144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE HEALTH CORP

Provider Business Mailing Address
First Line	:	17368 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17368 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-4319
Country	:	US
Telephone Number	:	305-720-4919
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISETTE TERRE
Credential	:
Telephone Number	:	786-397-0652

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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Directions to “PROMISE HEALTH CORP ” Practice Location

Language	Start Address	Practice Location

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