Healthcare Provider Details

I. General information

NPI: 1609252311
Provider Name (Legal Business Name): MGR HOME #2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 01/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 SW 119TH ST
MIAMI FL
33186
US

IV. Provider business mailing address

13620 SW 119TH ST
MIAMI FL
33186
US

V. Phone/Fax

Practice location:
  • Phone: 786-502-3152
  • Fax: 786-502-3152
Mailing address:
  • Phone: 786-502-3152
  • Fax: 786-502-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number11907
License Number StateFL

VIII. Authorized Official

Name: BERTHA RIAL
Title or Position: OWNER
Credential:
Phone: 786-797-5322