Provider Demographics
NPI:1013628593
Name:MAGNOLIA ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:MAGNOLIA ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-934-1122
Mailing Address - Street 1:17141 COLLINS AVE UNIT 1201
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5363
Mailing Address - Country:US
Mailing Address - Phone:720-934-1122
Mailing Address - Fax:303-484-4024
Practice Address - Street 1:850 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4845
Practice Address - Country:US
Practice Address - Phone:720-934-1122
Practice Address - Fax:303-484-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care