Provider Demographics
NPI:1609272913
Name:MEMORIES ADULT DAY CARE CENTER, LLC.
Entity Type:Organization
Organization Name:MEMORIES ADULT DAY CARE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-598-0786
Mailing Address - Street 1:124 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6844
Mailing Address - Country:US
Mailing Address - Phone:561-598-0786
Mailing Address - Fax:
Practice Address - Street 1:124 W 13TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6844
Practice Address - Country:US
Practice Address - Phone:561-598-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12563310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility