Healthcare Provider Details

I. General information

NPI: 1326433814
Provider Name (Legal Business Name): TRAILWINDS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14929 SW 39TH ST
MIAMI FL
33185-3930
US

IV. Provider business mailing address

14929 SW 39TH ST
MIAMI FL
33185-3930
US

V. Phone/Fax

Practice location:
  • Phone: 786-258-2640
  • Fax: 305-220-1845
Mailing address:
  • Phone: 786-258-2640
  • Fax: 305-220-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12639
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAL12639
License Number StateFL

VIII. Authorized Official

Name: MR. JASON ANTHONY OSPINA
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-258-2640