MEDICARE: CAPE AMERICAN 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487313003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE AMERICAN FACILITY LLC

Provider Business Mailing Address
First Line	:	18 SW 19TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 SW 19TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3705
Country	:	US
Telephone Number	:	786-246-0305
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAZARO GARCIA
Credential	:
Telephone Number	:	786-246-0305

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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Directions to “CAPE AMERICAN FACILITY LLC ” Practice Location

Language	Start Address	Practice Location

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