Provider Demographics
NPI:1417255951
Name:MILTAS PLACE INC.
Entity Type:Organization
Organization Name:MILTAS PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-621-9143
Mailing Address - Street 1:17320 N.W. 19TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4812
Mailing Address - Country:US
Mailing Address - Phone:305-621-9143
Mailing Address - Fax:305-624-2440
Practice Address - Street 1:17320 NW 19TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4812
Practice Address - Country:US
Practice Address - Phone:305-621-9143
Practice Address - Fax:305-624-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385H00000X
385HR2050X, 385HR2055X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child