=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922397348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME SWEET HOME OF BISCAYNE.LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2011
-----------------------------------------------------
Last Update Date | 04/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 NE 82ND ST MIAMI
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-796-5840
-----------------------------------------------------
Fax | 305-846-9731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 931 NE 82ND ST MIAMI
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-796-5840
-----------------------------------------------------
Fax | 305-846-9731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ABEL BARRIOS I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-796-5840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL11923
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------