Provider Demographics
NPI:1114362720
Name:SAN JOSE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:SAN JOSE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASARIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-768-0184
Mailing Address - Street 1:7865 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6522
Mailing Address - Country:US
Mailing Address - Phone:786-768-0184
Mailing Address - Fax:
Practice Address - Street 1:7865 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6522
Practice Address - Country:US
Practice Address - Phone:786-768-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care