Healthcare Provider Details

I. General information

NPI: 1932576964
Provider Name (Legal Business Name): LAOS GROUP HOME CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 SW 146TH CT
MIAMI FL
33184-3260
US

IV. Provider business mailing address

1443 SW 146TH CT
MIAMI FL
33184-3260
US

V. Phone/Fax

Practice location:
  • Phone: 786-477-2935
  • Fax:
Mailing address:
  • Phone: 786-477-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12717
License Number StateFL

VIII. Authorized Official

Name: ELDA ISERN
Title or Position: PRESIDENT
Credential:
Phone: 786-477-2935