Provider Demographics
NPI:1609598267
Name:PEDIATRIC MEDICAL DAYCARE OF HOLLYWOOD, LLC
Entity Type:Organization
Organization Name:PEDIATRIC MEDICAL DAYCARE OF HOLLYWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-731-3350
Mailing Address - Street 1:5310 NW 33RD AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6319
Mailing Address - Country:US
Mailing Address - Phone:954-731-3350
Mailing Address - Fax:
Practice Address - Street 1:6603 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4010
Practice Address - Country:US
Practice Address - Phone:954-982-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center