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General NPI Number Information
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NPI Number | 1427358381
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Entity Type | Organization
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Legal Business Name | ADULT FAMILY CARE HOME MARTHA ROMAN
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 10275 SW 34TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3805
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Country | US
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Telephone | 305-225-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 10275 SW 34TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA ROMAN
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Credential |
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Telephone | 305-225-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 6905632
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License Number State | FL
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