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General NPI Number Information
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NPI Number | 1871004630
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Entity Type | Organization
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Legal Business Name | PRESTIGE CARE AVENTURA LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 19840 NE 26TH AVE
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City | MIAMI
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State | FL
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Zip | 33180-2208
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Country | US
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Telephone | 305-912-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 19840 NE 26TH AVE
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City | MIAMI
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State | FL
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Zip | 33180-2208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROMAN GOLDENBERG
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Credential |
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Telephone | 305-397-3829
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12991
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License Number State | FL
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