Healthcare Provider Details

I. General information

NPI: 1437355245
Provider Name (Legal Business Name): MIRAMAR SENIOR LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14833 SW 24TH ST
MIAMI FL
33185-5633
US

IV. Provider business mailing address

14833 SW 24TH ST
MIAMI FL
33185-5633
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-1275
  • Fax:
Mailing address:
  • Phone: 305-305-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL10593
License Number StateFL

VIII. Authorized Official

Name: VINCENT HERRYMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-305-1275