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General NPI Number Information
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NPI Number | 1043763238
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Entity Type | Organization
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Legal Business Name | SANCAN ALF, INC C/O JOAN SUCKIE-WILIAMS
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 50 NW 184TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4512
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Country | US
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Telephone | 305-653-4436
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Fax | 305-653-4436
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Provider Business Mailing Address
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Address Line | 50 NW 184TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4512
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Country | US
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Telephone | 305-653-4436
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Fax | 305-653-4436
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Authorized Official
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Title or Position | OWENER /
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Name | JOAN SUCKIE-WILLIAMS SUCKIE-WILLIAMS
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Credential |
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Telephone | 305-653-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL11891
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License Number State | FL
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