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General NPI Number Information
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NPI Number | 1306099742
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Entity Type | Organization
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Legal Business Name | ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 50 NW 184TH TER
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City | MIAMI
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State | FL
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Zip | 33169-4512
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Country | US
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Telephone | 305-653-4436
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Fax |
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Provider Business Mailing Address
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Address Line | 50 NW 184TH TER
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City | MIAMI
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State | FL
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Zip | 33169-4512
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Country | US
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Telephone | 305-653-4436
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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. MURTLE SUCKIE
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Credential |
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Telephone | 305-653-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 110340
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License Number State | FL
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