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General NPI Number Information
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NPI Number | 1104121466
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Entity Type | Organization
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Legal Business Name | INTRAQUAL PREMIER INC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 19117 NW 33RD AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-7406
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Country | US
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Telephone | 305-621-1051
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Fax | 305-628-4855
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Provider Business Mailing Address
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Address Line | 19117 NW 33RD AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-7406
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Country | US
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Telephone | 305-621-1051
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Fax | 305-628-4855
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TIFFANY GORDON
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Credential |
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Telephone | 305-724-1974
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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 | AL11941
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License Number State | FL
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