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General NPI Number Information
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NPI Number | 1417481656
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Entity Type | Organization
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Legal Business Name | A SENIOR LIVING DREAM LLC
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 13442 SW 284 TH STREET
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City | HOMESTEAD
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State | FL
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Zip | 33033-1942
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Country | US
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Telephone | 609-428-9360
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Fax | 305-602-8167
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Provider Business Mailing Address
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Address Line | 13442 SW 284 TH STREET
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City | HOMESTEAD
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State | FL
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Zip | 33033
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Country | US
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Telephone | 786-786-3495
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Fax | 305-602-8167
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBINSON GRACIANO
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Credential | PRESIDENT
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Telephone | 609-428-9360
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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 | 12831
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License Number State | FL
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