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General NPI Number Information
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NPI Number | 1073724829
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Entity Type | Organization
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Legal Business Name | BERTHA ELDERLY CARE
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 9760 MEMORIAL RD
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City | MIAMI
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State | FL
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Zip | 33157-8744
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Country | US
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Telephone | 305-278-1351
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Fax | 305-225-1289
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Provider Business Mailing Address
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Address Line | 9760 MEMORIAL RD
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City | MIAMI
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State | FL
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Zip | 33157-8744
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Country | US
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Telephone | 305-278-1351
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Fax | 305-225-1289
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Authorized Official
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Title or Position | OWNER
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Name | LUIS MONTOYA
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Credential |
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Telephone | 305-278-1351
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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 | AL10852
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License Number State | FL
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