Healthcare Provider Details

I. General information

NPI: 1790846079
Provider Name (Legal Business Name): HIALEAH ENTERPRISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W 28TH ST
HIALEAH FL
33010-1606
US

IV. Provider business mailing address

190 W 28TH ST
HIALEAH FL
33010-1606
US

V. Phone/Fax

Practice location:
  • Phone: 305-885-2437
  • Fax: 305-884-1035
Mailing address:
  • Phone: 305-885-2437
  • Fax: 305-884-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1227096
License Number StateFL

VIII. Authorized Official

Name: EMMA DIAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-885-2437