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General NPI Number Information
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NPI Number | 1568824381
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Entity Type | Organization
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Legal Business Name | NONNA GLORIA ALF, INC.
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 12748 NW 98TH CT
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-7422
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Country | US
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Telephone | 305-820-3329
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Fax | 305-820-3329
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Provider Business Mailing Address
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Address Line | 12748 N.W. 98 CT.
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-1331
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Country | US
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Telephone | 305-820-3329
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Fax | 305-820-3329
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Authorized Official
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Title or Position | OWNER/ADMIN.
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Name | MILEISY PEDROZO
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Credential |
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Telephone | 305-820-3329
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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 | 10339
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License Number State | FL
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