Healthcare Provider Details

I. General information

NPI: 1508029406
Provider Name (Legal Business Name): MGR HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 SW 137TH CT
MIAMI FL
33175-6024
US

IV. Provider business mailing address

5305 SW 137TH CT
MIAMI FL
33175-6024
US

V. Phone/Fax

Practice location:
  • Phone: 786-431-5504
  • Fax: 786-431-5504
Mailing address:
  • Phone: 786-431-5504
  • Fax: 786-431-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11295
License Number StateFL

VIII. Authorized Official

Name: LYHA MORALES
Title or Position: OWNER
Credential:
Phone: 786-209-5597