Healthcare Provider Details

I. General information

NPI: 1336477256
Provider Name (Legal Business Name): NORCRIST HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 NW 8TH ST
MIAMI FL
33136-3269
US

IV. Provider business mailing address

542 NW 8TH ST
MIAMI FL
33136-3269
US

V. Phone/Fax

Practice location:
  • Phone: 305-358-7610
  • Fax: 305-631-1476
Mailing address:
  • Phone: 305-358-7610
  • Fax: 305-631-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11671
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL11671
License Number StateFL

VIII. Authorized Official

Name: MARIA CRISTINA RODRIGUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-358-7610