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General NPI Number Information
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NPI Number | 1477960136
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Entity Type | Organization
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Legal Business Name | LEALTAD ADULT LIVING FACILITY, INC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 12725 SW 32ND TER 3056398118
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City | MIAMI
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State | FL
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Zip | 33175-2646
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Country | US
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Telephone | 305-639-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 12725 SW 32ND TER 3056398118
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City | MIAMI
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State | FL
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Zip | 33175-2646
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Country | US
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Telephone | 305-639-8118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARA MARIA PEDRAZA
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Credential |
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Telephone | 305-639-8118
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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 | 12527
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License Number State | FL
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