Provider Demographics
NPI:1598461105
Name:AMIGOS SOCIAL CLUB LLC
Entity Type:Organization
Organization Name:AMIGOS SOCIAL CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-389-6913
Mailing Address - Street 1:5824 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2603
Mailing Address - Country:US
Mailing Address - Phone:786-542-1819
Mailing Address - Fax:305-960-7529
Practice Address - Street 1:5824 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2603
Practice Address - Country:US
Practice Address - Phone:786-542-1819
Practice Address - Fax:305-960-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care