=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124456496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RODRIGUEZ ALF # 2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2013
-----------------------------------------------------
Last Update Date | 10/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20602 NW 33RD CT
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33056-1348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-4179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4505 NW 199TH ST
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-1554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LYDIA RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-624-8086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------