Healthcare Provider Details

I. General information

NPI: 1639631054
Provider Name (Legal Business Name): MICASA ALF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 DUVAL ST
HOLLYWOOD FL
33024-7961
US

IV. Provider business mailing address

6920 SW 56TH CT
DAVIE FL
33314-7004
US

V. Phone/Fax

Practice location:
  • Phone: 954-613-1163
  • Fax:
Mailing address:
  • Phone: 954-613-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROZENBERG
Title or Position: OWNER
Credential:
Phone: 954-646-1212