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General NPI Number Information
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NPI Number | 1720256829
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Entity Type | Organization
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Legal Business Name | ST. MARY ADULT CARE
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 11271 SW 229TH TER
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City | MIAMI
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State | FL
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Zip | 33170-7563
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Country | US
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Telephone | 786-504-2397
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Fax | 305-408-1263
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Provider Business Mailing Address
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Address Line | PO BOX 771120
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City | MIAMI
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State | FL
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Zip | 33177-0019
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Country | US
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Telephone | 786-393-8122
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Fax | 305-408-1263
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR
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Name | MISS ELENA FERNANDEZ
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Credential |
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Telephone | 786-393-8122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL11069
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License Number State | FL
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