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General NPI Number Information
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NPI Number | 1730339136
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Entity Type | Organization
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Legal Business Name | MY FAMILY HOME ALF II
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 20560 SW 113TH RD
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City | MIAMI
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State | FL
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Zip | 33189-2202
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Country | US
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Telephone | 305-259-3607
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Fax | 305-259-9607
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Provider Business Mailing Address
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Address Line | 20560 SW 113TH RD
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City | MIAMI
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State | FL
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Zip | 33189-2202
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Country | US
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Telephone | 305-259-3607
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Fax | 305-259-9607
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUSTAVO E RELOBA
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Credential |
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Telephone | 305-259-3607
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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 | AL10272
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License Number State | FL
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