=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992982086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABRIELS HOME ALF, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 04/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11232 SW 7TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9860
-----------------------------------------------------
Fax | 305-675-7668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11232 SW 7TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9860
-----------------------------------------------------
Fax | 305-675-7668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ORLANDO MUNIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-273-8975
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 7810
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------