Provider Demographics
NPI:1023720034
Name:LITTLE HAVANA ACTIVITIES & NUTRITION CENTERS OF DADE COUNTY INC
Entity type:Organization
Organization Name:LITTLE HAVANA ACTIVITIES & NUTRITION CENTERS OF DADE COUNTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-473-3000
Mailing Address - Street 1:700 SW 8TH ST FL 33130
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:
Practice Address - Street 1:700 SW 8TH ST FL 33130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3311
Practice Address - Country:US
Practice Address - Phone:305-858-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113535900Medicaid