=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720269111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M.D.R. CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 11/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13920 SW 71ST LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-546-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13920 SW 71ST LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-546-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ELOINA ESTEVEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-546-7394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10120
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------