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General NPI Number Information
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NPI Number | 1376751685
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Entity Type | Organization
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Legal Business Name | EDELMIRA ALF
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 19720 SW 116TH AVE
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City | MIAMI
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State | FL
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Zip | 33157-1043
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Country | US
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Telephone | 305-253-0649
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Fax | 305-253-0649
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Provider Business Mailing Address
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Address Line | 19720 SW 116TH AVE
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City | MIAMI
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State | FL
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Zip | 33157-1043
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Country | US
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Telephone | 305-253-0649
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Fax | 305-225-4253
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EDELMIRA JIMENEZ
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Credential |
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Telephone | 305-562-6163
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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 | AL 9683
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License Number State | FL
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