MEDICARE: EAGLE ADULT WELLNESS CENTER 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

General Provider Information

NPI Number	:	1649064106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE ADULT WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	7519 PAULA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7519 PAULA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4113
Country	:	US
Telephone Number	:	813-397-1311
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MERLYS GUTIERREZ
Credential	:
Telephone Number	:	813-397-1311

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	12/02/2025

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