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General NPI Number Information
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NPI Number | 1023475480
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Entity Type | Organization
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Legal Business Name | SUPERIOR ALF II INC.
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 14750 SW 284TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-1528
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Country | US
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Telephone | 786-504-8181
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Fax | 866-811-8194
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Provider Business Mailing Address
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Address Line | 14750 SW 284TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-1528
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Country | US
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Telephone | 786-504-8181
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Fax | 866-811-8194
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Authorized Official
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Title or Position | OWNER/ADMIN.
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Name | VICTOR M FAGUNDO
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Credential |
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Telephone | 786-504-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12777
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License Number State | FL
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