MEDICARE: ST ALBAN'S DAY NURSERY 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	252Y00000X	Early Intervention Provider Agency	PY8446	FL
2	251S00000X	Community/Behavioral Health Agency	PY8446	FL

General Provider Information

NPI Number	:	1982941233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ALBAN'S DAY NURSERY INC

Provider Business Mailing Address
First Line	:	3465 BROOKER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4867
Country	:	US
Telephone Number	:	305-443-1234
Fax Number	:	305-443-7913

Provider Business Practice Location Address
First Line	:	3465 BROOKER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4867
Country	:	US
Telephone Number	:	305-443-1234
Fax Number	:	305-443-7913

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. SABRINA TASSY-LEWIS
Credential	:	PSY.D
Telephone Number	:	305-443-1234

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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