Provider Demographics
NPI:1962077065
Name:MIS ABUELITOS ADULT DAY CARE CORP.
Entity type:Organization
Organization Name:MIS ABUELITOS ADULT DAY CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-720-8475
Mailing Address - Street 1:14904 SW 168TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1762
Mailing Address - Country:US
Mailing Address - Phone:786-720-8475
Mailing Address - Fax:
Practice Address - Street 1:8290 SW 40TH ST STE 101-102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3312
Practice Address - Country:US
Practice Address - Phone:786-715-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9417Medicaid