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General NPI Number Information
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NPI Number | 1316248792
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Entity Type | Organization
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Legal Business Name | PETSIRL GROUP HOME, INC.
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 8361 NE 3RD AVE
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City | MIAMI
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State | FL
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Zip | 33138-3905
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Country | US
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Telephone | 305-318-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 8361 NE 3RD AVE
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City | MIAMI
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State | FL
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Zip | 33138-3905
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Country | US
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Telephone | 305-318-6650
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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 | LEONISE WALKER
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Credential |
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Telephone | 305-318-6650
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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 | AL11895
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License Number State | FL
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