Provider Demographics
NPI:1376073510
Name:SENIOR ACTIVITY CENTER CORP
Entity Type:Organization
Organization Name:SENIOR ACTIVITY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ECHEMENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-6521
Mailing Address - Street 1:7801 CORAL WAY STE 136
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6538
Mailing Address - Country:US
Mailing Address - Phone:305-305-6521
Mailing Address - Fax:305-260-0061
Practice Address - Street 1:7801 CORAL WAY STE 136
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6538
Practice Address - Country:US
Practice Address - Phone:305-305-6521
Practice Address - Fax:305-260-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9392261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care