Healthcare Provider Details

I. General information

NPI: 1487039475
Provider Name (Legal Business Name): SAN JUDAS ALF GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 SW 47TH TER
MIAMI FL
33155-5449
US

IV. Provider business mailing address

8275 SW 47TH TER
MIAMI FL
33155-5449
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-4697
  • Fax:
Mailing address:
  • Phone: 786-536-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL11145
License Number StateFL

VIII. Authorized Official

Name: BARBARA P ALMIROLA
Title or Position: PRESIDENT
Credential:
Phone: 786-536-4697