Healthcare Provider Details

I. General information

NPI: 1780816280
Provider Name (Legal Business Name): TIKA'S ALF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14822 GARDEN DR
MIAMI FL
33168-4927
US

IV. Provider business mailing address

14822 GARDEN DR
MIAMI FL
33168-4927
US

V. Phone/Fax

Practice location:
  • Phone: 305-681-8382
  • Fax: 786-359-4414
Mailing address:
  • Phone: 305-681-8382
  • Fax: 786-359-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROLLE FOSTER
Title or Position: OWNER /ADMINISTRATOR
Credential:
Phone: 786-216-5033