Healthcare Provider Details

I. General information

NPI: 1578724423
Provider Name (Legal Business Name): MIRAMAR SENIOR LIVING VI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15364 SW 10TH ST
MIAMI FL
33194-2683
US

IV. Provider business mailing address

15364 SW 10TH ST
MIAMI FL
33194-2683
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 NumberAL11120
License Number StateFL

VIII. Authorized Official

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