Provider Demographics
NPI:1972104164
Name:EL PRADO SENIOR CLUB CORP
Entity type:Organization
Organization Name:EL PRADO SENIOR CLUB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-246-6519
Mailing Address - Street 1:1800 W 68TH ST STE 101-105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4404
Mailing Address - Country:US
Mailing Address - Phone:786-246-6519
Mailing Address - Fax:
Practice Address - Street 1:1800 W 68TH ST STE 101-105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4404
Practice Address - Country:US
Practice Address - Phone:786-246-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care