Basic Information
| Provider Information | |||||||||
| NPI: | 1336263581 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTEVERDE ADULT ACTIVITY CENTER, CORP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11865 SW 26TH ST | ||||||||
| Address2: | G-5 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331752400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054859141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11865 SW 26TH ST | ||||||||
| Address2: | G-5 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331752400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054859141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILLAN | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3054859141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | 9042 | FL | Y | Nursing & Custodial Care Facilities | Custodial Care Facility |
No ID Information.