=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639310022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COCO'S CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2009
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10670 SW 7TH TERRACE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-431-5710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10670 SW 7TH TERRACE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-413-7016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROBERTO BARRERAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-413-7016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL 11470
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------