Provider Demographics
NPI:1457638611
Name:LA EDAD DE ORO ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:LA EDAD DE ORO ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAIDELIN
Authorized Official - Middle Name:RAMONA
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-275-4628
Mailing Address - Street 1:5870 SW 8TH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174
Mailing Address - Country:US
Mailing Address - Phone:786-275-4628
Mailing Address - Fax:305-262-0189
Practice Address - Street 1:5870 SW 8TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5052
Practice Address - Country:US
Practice Address - Phone:786-275-4628
Practice Address - Fax:305-262-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9127261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002149600Medicaid