=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659675734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCEDES & FAMILY ALF, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2011
-----------------------------------------------------
Last Update Date | 01/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4941 NW 183RD ST
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-258-0994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4941 NW 183RD ST
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-258-0994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARJORIE HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-258-0994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 11927
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------