MEDICARE: SOUTH MIAMI SENIOR CARE

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	AL11202	FL

General Provider Information

NPI Number	:	1104072131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI SENIOR CARE

Provider Business Mailing Address
First Line	:	15592 SW 183RD LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6810
Country	:	US
Telephone Number	:	786-302-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	15592 SW 183RD LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6810
Country	:	US
Telephone Number	:	786-302-8272
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIA AURORA RIVERO
Credential	:
Telephone Number	:	786-302-8272

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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