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General NPI Number Information
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NPI Number | 1124465422
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Entity Type | Organization
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Legal Business Name | MI CASA ES TU CASA #2
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 6700 PARKER AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4550
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Country | US
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Telephone | 561-547-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 PARKER AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4550
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Country | US
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Telephone | 561-547-5474
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. ROSA E PESTANA
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Credential |
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Telephone | 561-547-5474
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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 | 9232
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License Number State | FL
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