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General NPI Number Information
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NPI Number | 1902560832
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Entity Type | Organization
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Legal Business Name | MI CASA ADULT LIVING FACILITY HOME, INC
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 6856 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2818
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Country | US
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Telephone | 904-739-3927
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Fax |
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Provider Business Mailing Address
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Address Line | 6856 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2818
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Country | US
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Telephone | 904-739-3927
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESUS R CASTILLO
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Credential |
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Telephone | 929-313-1665
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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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