=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811156169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGDA'S HOME CORPORTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2008
-----------------------------------------------------
Last Update Date | 06/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10551 SW 49TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-6223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-305-8711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10551 SW 49TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-6223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-305-8711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARIA TERESA GUERRERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-305-8711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL7963
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------