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General NPI Number Information
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NPI Number | 1710264916
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Entity Type | Organization
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Legal Business Name | NUESTRA CASA II INC.
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 2832 GIULIANO AVE
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City | LAKE WORTH
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State | FL
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Zip | 33461-3725
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Country | US
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Telephone | 561-541-1387
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Fax |
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Provider Business Mailing Address
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Address Line | 2832 GIULIANO AVE
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City | LAKE WORTH
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State | FL
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Zip | 33461-3725
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Country | US
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Telephone | 561-541-1387
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TANIA LOPEZ
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Credential |
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Telephone | 561-541-1387
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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-12032
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License Number State | FL
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