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General NPI Number Information
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NPI Number | 1609252311
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Entity Type | Organization
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Legal Business Name | MGR HOME #2 INC
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 13620 SW 119TH ST
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City | MIAMI
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State | FL
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Zip | 33186
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Country | US
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Telephone | 786-502-3152
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Fax | 786-502-3152
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Provider Business Mailing Address
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Address Line | 13620 SW 119TH ST
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City | MIAMI
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State | FL
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Zip | 33186
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Country | US
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Telephone | 786-502-3152
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Fax | 786-502-3152
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Authorized Official
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Title or Position | OWNER
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Name | BERTHA RIAL
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Credential |
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Telephone | 786-797-5322
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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 | 11907
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License Number State | FL
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