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General NPI Number Information
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NPI Number | 1720589187
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Entity Type | Organization
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Legal Business Name | REBULL SENIOR LIVING
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 10790 SW 43RD TER
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City | MIAMI
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State | FL
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Zip | 33165-4835
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Country | US
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Telephone | 786-775-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 SW 43RD TER
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City | MIAMI
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State | FL
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Zip | 33165-4835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS HERNANDEZ
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Credential |
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Telephone | 786-775-8696
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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 |
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License Number State |
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