Provider Demographics
NPI:1003212796
Name:DBS BABY BOOMERS ADULT DAY, HEALTH & ENRICHMENT CENTER
Entity Type:Organization
Organization Name:DBS BABY BOOMERS ADULT DAY, HEALTH & ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-360-1258
Mailing Address - Street 1:14734 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4067
Mailing Address - Country:US
Mailing Address - Phone:786-360-1258
Mailing Address - Fax:786-762-2182
Practice Address - Street 1:14734 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4067
Practice Address - Country:US
Practice Address - Phone:786-360-1258
Practice Address - Fax:786-762-2182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BABY BOOMERS CASE MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-07
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care