Healthcare Provider Details

I. General information

NPI: 1124234083
Provider Name (Legal Business Name): SOUTH DEERING RETIREMENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 COLONIAL DR
MIAMI FL
33157-3347
US

IV. Provider business mailing address

9730 COLONIAL DR
MIAMI FL
33157-3347
US

V. Phone/Fax

Practice location:
  • Phone: 786-293-2816
  • Fax:
Mailing address:
  • Phone: 786-293-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number8674
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number8674
License Number StateFL

VIII. Authorized Official

Name: ISISE E MOLINA
Title or Position: PRESIDENT
Credential:
Phone: 786-293-2816