MEDICARE: IDEAL STAY ADULT DAY CARE AND REHAB CENTER INC.

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		FL

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	:	1891173787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL STAY ADULT DAY CARE AND REHAB CENTER INC.

Provider Business Mailing Address
First Line	:	2164 JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6015
Country	:	US
Telephone Number	:	305-300-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2164 JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6015
Country	:	US
Telephone Number	:	305-300-6447
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EDUAR RIOS
Credential	:
Telephone Number	:	305-300-6447

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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