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General NPI Number Information
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NPI Number | 1659609014
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Entity Type | Organization
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Legal Business Name | NUESTRA CASA
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 1906 N A ST
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City | LAKE WORTH
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State | FL
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Zip | 33460-6002
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Country | US
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Telephone | 561-493-1785
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 N 'A' STREET
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City | LAKE WORTH
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State | FL
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Zip | 33460
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Country | US
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Telephone | 561-493-1785
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CONRADO BARRIO
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Credential |
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Telephone | 561-252-6399
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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 | 11471
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License Number State | FL
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