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General NPI Number Information
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NPI Number | 1396366621
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Entity Type | Organization
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Legal Business Name | CASA DE CAMPO ALF LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 4173 NE 20TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-5357
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Country | US
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Telephone | 786-601-9299
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Fax | 786-601-9299
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Provider Business Mailing Address
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Address Line | 4173 NE 20TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-5357
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Country | US
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Telephone | 786-601-9299
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Fax | 786-601-9299
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Authorized Official
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Title or Position | OWNER
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Name | MILEIDYS JACOMINO MARTINEZ
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Credential |
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Telephone | 305-479-0022
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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 |
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License Number State |
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