MEDICARE: RICHLAND RETIREMENT HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9475	OTHER	FL	AHCA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013582618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHLAND RETIREMENT HOME LLC

Provider Business Mailing Address
First Line	:	3508 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2009
Country	:	US
Telephone Number	:	305-444-7776
Fax Number	:	305-444-7776

Provider Business Practice Location Address
First Line	:	3508 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2009
Country	:	US
Telephone Number	:	305-444-7776
Fax Number	:	305-444-7776

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL PEREZ
Credential	:
Telephone Number	:	786-281-3790

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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