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General NPI Number Information
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NPI Number | 1811473317
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Entity Type | Organization
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Legal Business Name | LIFE RESIDENTIAL LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 13431 S.W. 178 ST.
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City | MIAMI
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State | FL
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Zip | 33177
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Country | US
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Telephone | 305-971-3628
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Fax | 305-602-3165
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Provider Business Mailing Address
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Address Line | 13431 S.W. 178 ST.
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City | MIAMI
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State | FL
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Zip | 33177
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Country | US
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Telephone | 305-971-3628
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Fax | 305-602-3165
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Authorized Official
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Title or Position | OWNER
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Name | SINDY LEYRAS CASTRO
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Credential |
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Telephone | 786-322-0603
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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 | 11001
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License Number State | FL
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