MEDICARE: PADRE PIO ADULT CONGREGATE LIVING FACILITY, 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	8699	FL
2	3104A0625X	Assisted Living Facility (Mental Illness)	8699	FL

General Provider Information

NPI Number	:	1831392646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PADRE PIO ADULT CONGREGATE LIVING FACILITY, INC

Provider Business Mailing Address
First Line	:	403 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	305-264-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	305-264-7431
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORGE E LOPEZ
Credential	:
Telephone Number	:	305-264-7431

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/11/2025

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