Healthcare Provider Details

I. General information

NPI: 1104922715
Provider Name (Legal Business Name): DOS OF NORTH SHORE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 NW 7TH AVE
MIAMI FL
33150-2012
US

IV. Provider business mailing address

9380 NW 7TH AVE
MIAMI FL
33150-2012
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-8711
  • Fax: 305-757-8860
Mailing address:
  • Phone: 305-759-8711
  • Fax: 305-757-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1372096
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE R HERNANDO
Title or Position: OWNER
Credential:
Phone: 305-868-1830