=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245869791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY WELFARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2020
-----------------------------------------------------
Last Update Date | 04/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26901 SW 143RD CT
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-7538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-349-5525
-----------------------------------------------------
Fax | 786-349-5525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26901 SW 143RD CT
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-7538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-349-5525
-----------------------------------------------------
Fax | 786-349-5525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OMAR MENDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-910-9465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------