Provider Demographics
NPI:1497912810
Name:LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC
Entity Type:Organization
Organization Name:LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC
Other - Org Name:LHANC - MP ADC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-2226
Mailing Address - Street 1:700 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3311
Mailing Address - Country:US
Mailing Address - Phone:305-858-0887
Mailing Address - Fax:305-854-2226
Practice Address - Street 1:10000 SW 56TH ST
Practice Address - Street 2:SUIITE 25-26
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7165
Practice Address - Country:US
Practice Address - Phone:305-271-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683270900Medicaid