MEDICARE: MORENO FACILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13968	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1043014707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORENO FACILITY LLC

Provider Business Mailing Address
First Line	:	11870 SW 186TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-3271
Country	:	US
Telephone Number	:	786-701-8929
Fax Number	:	786-701-8929

Provider Business Practice Location Address
First Line	:	11870 SW 186TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-3271
Country	:	US
Telephone Number	:	786-701-8929
Fax Number	:	786-701-8929

Authorized Official
Title or Position	:	OWNER
Name	:	MIZAYDA MORENO MARTINEZ
Credential	:
Telephone Number	:	786-444-3816

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	02/18/2026

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