Healthcare Provider Details

I. General information

NPI: 1790218220
Provider Name (Legal Business Name): LLINA'S ALF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28122 SW 160TH CT
HOMESTEAD FL
33033-1126
US

IV. Provider business mailing address

28122 SW 160TH CT
HOMESTEAD FL
33033-1126
US

V. Phone/Fax

Practice location:
  • Phone: 786-610-0818
  • Fax: 305-224-1884
Mailing address:
  • Phone: 786-610-0818
  • Fax: 305-224-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number12992
License Number StateFL

VIII. Authorized Official

Name: LLINY DE LA NUEZ
Title or Position: OWNER/ADMIN.
Credential:
Phone: 786-610-0818