=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366748915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IYA-KERE ALF INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2011
-----------------------------------------------------
Last Update Date | 01/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 NW 56TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-6505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 NW 56TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-6505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JOSE L QUINONEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-317-6505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL11338
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------