MEDICARE: MIRLANDE JONES

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)	AL7823	FL

General Provider Information

NPI Number	:	1831588235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRLANDE JONES

Provider Business Mailing Address
First Line	:	15900 NE 19TH CT
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5783
Country	:	US
Telephone Number	:	305-956-7766
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 NE 19TH CT
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5783
Country	:	US
Telephone Number	:	305-956-7766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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Directions to “ MIRLANDE JONES ” Practice Location

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