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General NPI Number Information
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NPI Number | 1891983573
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Entity Type | Organization
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Legal Business Name | XANADU'S PALACE FAMILY HOME, INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 8070 SW 157TH PL
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City | MIAMI
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State | FL
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Zip | 33193-3024
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Country | US
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Telephone | 305-632-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 8070 SW 157TH PL
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City | MIAMI
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State | FL
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Zip | 33193-3024
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Country | US
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Telephone | 305-632-6888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAYQUEL QUINTANA
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Credential |
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Telephone | 305-632-6888
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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 | 10386
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License Number State | FL
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