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General NPI Number Information
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NPI Number | 1790846079
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Entity Type | Organization
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Legal Business Name | HIALEAH ENTERPRISE, LLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 190 W 28TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-1606
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Country | US
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Telephone | 305-885-2437
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Fax | 305-884-1035
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Provider Business Mailing Address
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Address Line | 190 W 28TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-1606
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Country | US
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Telephone | 305-885-2437
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Fax | 305-884-1035
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EMMA DIAL
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Credential |
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Telephone | 305-885-2437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1227096
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License Number State | FL
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