MEDICARE: NUEVA VIDA GARDENS ALF CORP.

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	:	1750910204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUEVA VIDA GARDENS ALF CORP.

Provider Business Mailing Address
First Line	:	18078 NW 41ST CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3425
Country	:	US
Telephone Number	:	786-757-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	18078 NW 41ST CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3425
Country	:	US
Telephone Number	:	786-757-0065
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MIRIELA GARCIA
Credential	:
Telephone Number	:	786-757-0065

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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