Provider Demographics
NPI:1346593449
Name:ADULT DAY CENTER OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:ADULT DAY CENTER OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-975-2797
Mailing Address - Street 1:9855 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6934
Mailing Address - Country:US
Mailing Address - Phone:305-975-2797
Mailing Address - Fax:
Practice Address - Street 1:9855 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6934
Practice Address - Country:US
Practice Address - Phone:305-975-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218261QA0600X
FL311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care