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General NPI Number Information
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NPI Number | 1114189438
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Entity Type | Organization
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Legal Business Name | GENESIS ADUL CARE D/B/A AMOR DE DIOS (ALF)
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 718 NW 132ND PL
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City | MIAMI
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State | FL
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Zip | 33182-1810
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Country | US
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Telephone | 786-306-2610
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Fax |
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Provider Business Mailing Address
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Address Line | 718 NW 132ND PL
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City | MIAMI
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State | FL
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Zip | 33182-1810
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Country | US
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Telephone | 786-306-2610
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | ELVIS QUINTANA
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Credential |
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Telephone | 305-485-1225
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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 | AL10069
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License Number State | FL
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