MEDICARE: PARADISE SOCIAL CLUB ADULT DAY CARE, 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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1508459744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE SOCIAL CLUB ADULT DAY CARE, CORP

Provider Business Mailing Address
First Line	:	3810 E 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2704
Country	:	US
Telephone Number	:	305-934-8770
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 E 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2704
Country	:	US
Telephone Number	:	305-934-8770
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARMEN DELAMATA
Credential	:
Telephone Number	:	305-934-8770

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	02/18/2021

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