Provider Demographics
NPI:1750680658
Name:ACTIVE ADULT DAY CARE CENTER LLC
Entity Type:Organization
Organization Name:ACTIVE ADULT DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:PILOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-635-9933
Mailing Address - Street 1:1470 NW 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142
Mailing Address - Country:US
Mailing Address - Phone:305-635-9933
Mailing Address - Fax:305-635-9767
Practice Address - Street 1:1470 NW 36TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:305-635-9933
Practice Address - Fax:305-635-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9123311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002011600Medicaid