Provider Demographics
NPI:1699417741
Name:SUPREME ADULT DAY CARE, INC
Entity type:Organization
Organization Name:SUPREME ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-846-9345
Mailing Address - Street 1:8250 W 21ST LN STE 100
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1908
Mailing Address - Country:US
Mailing Address - Phone:305-846-9345
Mailing Address - Fax:305-392-0316
Practice Address - Street 1:8250 W 21ST LN STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1908
Practice Address - Country:US
Practice Address - Phone:305-846-9345
Practice Address - Fax:305-392-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care