MEDICARE: CASA DE LOS ANGELES, 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	AL12863	FL

General Provider Information

NPI Number	:	1598218729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA DE LOS ANGELES, LLC

Provider Business Mailing Address
First Line	:	1239 MYRTLE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3515
Country	:	US
Telephone Number	:	407-844-7728
Fax Number	:	407-381-8541

Provider Business Practice Location Address
First Line	:	1239 MYRTLE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3515
Country	:	US
Telephone Number	:	407-844-7728
Fax Number	:	407-381-8541

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DAISY MORFA
Credential	:
Telephone Number	:	407-844-7728

Provider Enumeration Date	:	07/23/2016
Last Update Date	:	07/23/2016

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