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General NPI Number Information
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NPI Number | 1174812341
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Entity Type | Organization
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Legal Business Name | MILLER DRIVE & GALLOWAY FAMILY HOME II
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 6650 SW 79TH AVE
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City | MIAMI
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State | FL
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Zip | 33143-2625
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Country | US
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Telephone | 305-761-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 6650 SW 79TH AVE
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City | MIAMI
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State | FL
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Zip | 33143-2625
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Country | US
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Telephone | 305-761-4445
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Fax |
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | FAUSTINO FERNANDEZ
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Credential |
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Telephone | 305-761-4445
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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 | AL-11969
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License Number State | FM
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