MEDICARE: MARCIA ADULT CARE #1, INC

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	AL10575	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104087626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCIA ADULT CARE #1, INC

Provider Business Mailing Address
First Line	:	5143 SW 157TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5017
Country	:	US
Telephone Number	:	305-951-4910
Fax Number	:

Provider Business Practice Location Address
First Line	:	5143 SW 157TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5017
Country	:	US
Telephone Number	:	305-951-4910
Fax Number	:

Authorized Official
Title or Position	:	ALF ADMINISTRATOR
Name	:	MS. NIURKA PRADO
Credential	:
Telephone Number	:	305-485-0478

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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