Provider Demographics
NPI:1396088936
Name:AZUCAR ADULT DAY CARE
Entity type:Organization
Organization Name:AZUCAR ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-815-8367
Mailing Address - Street 1:8655 SW 24TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2337
Mailing Address - Country:US
Mailing Address - Phone:305-815-8367
Mailing Address - Fax:305-748-2544
Practice Address - Street 1:8655 SW 24TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2337
Practice Address - Country:US
Practice Address - Phone:305-815-8367
Practice Address - Fax:305-748-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9235OtherAGENCY FOR HEALTH CARE ADMINISTRATION- DIVISION OF HEALTH QUALITY ASSURANCE