Provider Demographics
NPI:1881851426
Name:LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY
Entity Type:Organization
Organization Name:LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY
Other - Org Name:LHANC - HIA ADC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-858-0887
Mailing Address - Street 1:700 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3311
Mailing Address - Country:US
Mailing Address - Phone:305-858-0887
Mailing Address - Fax:305-854-2226
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:SUITE #28C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-558-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683269500Medicaid