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General NPI Number Information
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NPI Number | 1568824746
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Entity Type | Organization
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Legal Business Name | M. D. RETIREMENT HOME, INC.
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 13920 SW 71ST LN
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City | MIAMI
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State | FL
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Zip | 33183-2112
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Country | US
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Telephone | 305-386-4259
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Fax | 305-386-4259
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Provider Business Mailing Address
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Address Line | 13920 SW 71ST LN
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City | MIAMI
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State | FL
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Zip | 33183-2112
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Country | US
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Telephone | 305-386-4259
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Fax | 305-386-4259
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RODOLFO GONZALEZ-CASTRO
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Credential |
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Telephone | 786-399-1239
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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 | AL10120
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License Number State | FL
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