Provider Demographics
NPI:1881263762
Name:PRECIOUS MOMENTS ADULT DAYCARE CENTER
Entity type:Organization
Organization Name:PRECIOUS MOMENTS ADULT DAYCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-266-6042
Mailing Address - Street 1:13460 NW 107TH AVE STE 5-6
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1184
Mailing Address - Country:US
Mailing Address - Phone:786-266-6042
Mailing Address - Fax:
Practice Address - Street 1:13460 NW 107TH AVE STE 5-6
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1184
Practice Address - Country:US
Practice Address - Phone:786-266-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9505Medicaid