MEDICARE: SANCAN ALF, INC C/O JOAN SUCKIE-WILIAMS

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL11891	FL

General Provider Information

NPI Number	:	1043763238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCAN ALF, INC C/O JOAN SUCKIE-WILIAMS

Provider Business Mailing Address
First Line	:	50 NW 184TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4512
Country	:	US
Telephone Number	:	305-653-4436
Fax Number	:	305-653-4436

Provider Business Practice Location Address
First Line	:	50 NW 184TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4512
Country	:	US
Telephone Number	:	305-653-4436
Fax Number	:	305-653-4436

Authorized Official
Title or Position	:	OWENER /
Name	:	JOAN SUCKIE-WILLIAMS SUCKIE-WILLIAMS
Credential	:
Telephone Number	:	305-653-4436

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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