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General NPI Number Information
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NPI Number | 1942453436
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Entity Type | Organization
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Legal Business Name | LA EXCELENCIA ALF CORP
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 16400 NW 82ND CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-3474
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Country | US
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Telephone | 786-402-1280
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Fax | 305-362-1920
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Provider Business Mailing Address
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Address Line | 16400 NW 82ND CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-3474
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Country | US
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Telephone | 786-402-1280
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Fax | 305-362-1920
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESUS A VARGAS
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Credential |
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Telephone | 786-514-5734
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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 | AL11462
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License Number State | FL
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