1063126043 NPI number — DOS GARDENIAS ADULT DAY CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063126043 NPI number — DOS GARDENIAS ADULT DAY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOS GARDENIAS ADULT DAY CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063126043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13501 SW 136TH ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-8321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-877-8657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13501 SW 136TH ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-8321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-877-8657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BENITEZ
Authorized Official First Name:
NIURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-877-8657

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9553 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116766000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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