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General NPI Number Information
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NPI Number | 1619130150
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Entity Type | Organization
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Legal Business Name | IDALMIS RESIDENCE INC.
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Dates
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Enumeration Date | 07/04/2008
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 3530 SW 12TH ST
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-446-5720
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 SW 12TH ST
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-446-5720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM GONZALEZ
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Credential |
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Telephone | 305-587-8650
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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 | AL 11187
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License Number State | FL
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