Provider Demographics
NPI:1962806968
Name:LIVING LIFE ADULT DAY CARE CORP.
Entity type:Organization
Organization Name:LIVING LIFE ADULT DAY CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-549-0948
Mailing Address - Street 1:1835 NW 112TH AVE STE 164-165
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1817
Mailing Address - Country:US
Mailing Address - Phone:305-463-0391
Mailing Address - Fax:305-463-0392
Practice Address - Street 1:1835 NW 112TH AVE STE 164-165
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1817
Practice Address - Country:US
Practice Address - Phone:305-463-0391
Practice Address - Fax:305-463-0392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING LIFE ADULT DAY CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9293261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care