Provider Demographics
NPI:1669724837
Name:LONE STAR ADULT DAY TRAINING
Entity type:Organization
Organization Name:LONE STAR ADULT DAY TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-849-5777
Mailing Address - Street 1:2150 CORAL WAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2629
Mailing Address - Country:US
Mailing Address - Phone:305-849-5777
Mailing Address - Fax:305-860-1151
Practice Address - Street 1:2150 CORAL WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2629
Practice Address - Country:US
Practice Address - Phone:305-849-5777
Practice Address - Fax:305-860-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home