Healthcare Provider Details

I. General information

NPI: 1457558280
Provider Name (Legal Business Name): LA COVADONGA RETIREMENT LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SW 20TH AVE
MIAMI FL
33135-3328
US

IV. Provider business mailing address

140 W 28TH ST
HIALEAH FL
33010-1606
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-5835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL4198
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL4198
License Number StateFL

VIII. Authorized Official

Name: CLAUDIA PACE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 305-863-0002