=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497307631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGRADO CORAZON ALF CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2019
-----------------------------------------------------
Last Update Date | 07/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4051 SW 95TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-353-2227
-----------------------------------------------------
Fax | 786-353-2227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4051 SW 95TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-353-2227
-----------------------------------------------------
Fax | 786-353-2227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMIN.
-----------------------------------------------------
Name | ESTELA FRUTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-761-3216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------