Provider Demographics
NPI:1659766780
Name:ESENCIA DE LA VIDA ADULT DAY CARE
Entity Type:Organization
Organization Name:ESENCIA DE LA VIDA ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-488-3503
Mailing Address - Street 1:4750 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1452
Mailing Address - Country:US
Mailing Address - Phone:786-488-3503
Mailing Address - Fax:
Practice Address - Street 1:4750 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1452
Practice Address - Country:US
Practice Address - Phone:786-488-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9284261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care