MEDICARE: AVILES FOREVER CARE OF MIAMI, 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	11245	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	:	1790039097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVILES FOREVER CARE OF MIAMI, INC

Provider Business Mailing Address
First Line	:	9365 SW 36TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4119
Country	:	US
Telephone Number	:	305-221-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	9365 SW 36TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4119
Country	:	US
Telephone Number	:	305-221-3866
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ODALIZ E FALSTREAU
Credential	:
Telephone Number	:	305-298-0292

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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