Healthcare Provider Details

I. General information

NPI: 1174042402
Provider Name (Legal Business Name): LOLITA HOME CARE ALF CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 SW 97TH CT
MIAMI FL
33165-5147
US

IV. Provider business mailing address

4124 SW 97TH CT
MIAMI FL
33165-5147
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-8907
  • Fax: 305-229-8907
Mailing address:
  • Phone: 305-229-8907
  • Fax: 305-229-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number8174
License Number StateFL

VIII. Authorized Official

Name: NOELVIS FERNANDEZ
Title or Position: OWNER/ADMIN.
Credential:
Phone: 786-329-2319