Provider Demographics
NPI:1083906259
Name:EMILY C MOISES DAY TRAINING CENTER
Entity Type:Organization
Organization Name:EMILY C MOISES DAY TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:305-888-8711
Mailing Address - Street 1:5643 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5854
Mailing Address - Country:US
Mailing Address - Phone:305-888-8711
Mailing Address - Fax:305-888-4947
Practice Address - Street 1:5643 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5854
Practice Address - Country:US
Practice Address - Phone:305-888-8711
Practice Address - Fax:305-888-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL687612998261QD1600X, 347C00000X
FL687612996261QD1600X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687612996Medicaid
FL687612998Medicaid