=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902252380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAS PALMAS ALF, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 10/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1170 N.W. 26 ST.
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-634-2851
-----------------------------------------------------
Fax | 305-634-3317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1170 N.W. 26 ST.
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-634-2851
-----------------------------------------------------
Fax | 305-634-3317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN ALVAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-760-5823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------