Healthcare Provider Details

I. General information

NPI: 1972841237
Provider Name (Legal Business Name): SWEET ANGELS HOME ALF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15680 NW 40TH CT
MIAMI GARDENS FL
33054-6762
US

IV. Provider business mailing address

15680 NW 40TH CT
MIAMI GARDENS FL
33054-6762
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-4163
  • Fax: 305-974-4195
Mailing address:
  • Phone: 305-974-4163
  • Fax: 305-974-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11612
License Number StateFL

VIII. Authorized Official

Name: DANIA PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-974-4163