=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255712691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M & Y CARING AND LOVING ALF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2015
-----------------------------------------------------
Last Update Date | 06/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22712 SW 103RD CT
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33190-1778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-254-6139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13280 SW 43RD ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-231-9146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YUDITH LAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-231-9146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10867
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------