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General NPI Number Information
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NPI Number | 1902016066
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Entity Type | Organization
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Legal Business Name | SHALON ALF
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7046 SW 103RD PL
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City | MIAMI
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State | FL
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Zip | 33173-1324
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Country | US
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Telephone | 786-444-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 2841 SW 142ND AVE
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City | MIAMI
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State | FL
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Zip | 33175-6537
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Country | US
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Telephone | 786-444-7465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESUS T MENECES
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Credential |
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Telephone | 786-444-7465
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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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