Provider Demographics
NPI:1053193268
Name:JERUSALEN SENIORS ADULT DAY CARE LLC
Entity type:Organization
Organization Name:JERUSALEN SENIORS ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-713-0868
Mailing Address - Street 1:13501 SW 128TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5863
Mailing Address - Country:US
Mailing Address - Phone:786-713-0868
Mailing Address - Fax:786-713-0872
Practice Address - Street 1:13501 SW 128TH ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5863
Practice Address - Country:US
Practice Address - Phone:786-713-0868
Practice Address - Fax:786-713-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care