Healthcare Provider Details

I. General information

NPI: 1679714323
Provider Name (Legal Business Name): MINERVA RETIREMENT HOME II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SW 68TH AVE
MIAMI FL
33144-2805
US

IV. Provider business mailing address

41 SW 68TH AVE
MIAMI FL
33144-2805
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-5346
  • Fax:
Mailing address:
  • Phone: 305-776-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10466
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL10466
License Number StateFL

VIII. Authorized Official

Name: MINERVA MARIN
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 305-776-5346