MEDICARE: ABC-ALSY ADULT DAY CARE II

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	:	1972042695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC-ALSY ADULT DAY CARE II

Provider Business Mailing Address
First Line	:	248 NW 9TH AVE
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-5754
Country	:	US
Telephone Number	:	305-242-5333
Fax Number	:	305-242-5360

Provider Business Practice Location Address
First Line	:	11150 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2845
Country	:	US
Telephone Number	:	305-242-5333
Fax Number	:	305-242-5360

Authorized Official
Title or Position	:	MRG
Name	:	DANIEL OROZCO
Credential	:
Telephone Number	:	305-242-5333

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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