Organization
MIS ABUELOS HOME CARE CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAGOBERTO MEDINA (OWNER)
(813) 784-0328
Entity
Organization
Contact information
Practice address
8422 WOODLAKE DR, TAMPA, FL 33615-1717
(813) 784-0328
(813) 886-1430
Mailing address
8422 WOODLAKE DR, TAMPA, FL 33615-1717
(813) 784-0328
(813) 886-1430
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
AL11421
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL11421
AHCA LICENSE
FL
Enumeration date
01/23/2014
Last updated
01/23/2014
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