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General NPI Number Information
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NPI Number | 1790151314
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Entity Type | Organization
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Legal Business Name | NORLAND RES HAB LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 19615 NW 12TH CT
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City | MIAMI
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State | FL
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Zip | 33169-3080
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Country | US
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Telephone | 305-653-0918
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Fax | 305-653-1720
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Provider Business Mailing Address
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Address Line | 19615 NW 12TH CT.
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City | MIAMI
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State | FL
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Zip | 33169
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Country | US
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Telephone | 305-974-4230
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Fax | 305-974-4143
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUFRACIA URENA
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Credential |
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Telephone | 305-974-4230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 11-236-GH
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License Number State | FL
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