MEDICARE: REBULL SENIOR LIVING

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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1720589187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBULL SENIOR LIVING

Provider Business Mailing Address
First Line	:	10790 SW 43RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10790 SW 43RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4835
Country	:	US
Telephone Number	:	786-775-8696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLOS HERNANDEZ
Credential	:
Telephone Number	:	786-775-8696

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “REBULL SENIOR LIVING ” Practice Location

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