MEDICARE: ADAM HOME #2, INC.

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	7196	FL
2	3104A0625X	Assisted Living Facility (Mental Illness)	7196	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073729935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM HOME #2, INC.

Provider Business Mailing Address
First Line	:	1045 W 2 AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010
Country	:	US
Telephone Number	:	305-888-7257
Fax Number	:	786-635-1201

Provider Business Practice Location Address
First Line	:	1045 W 2 AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010
Country	:	US
Telephone Number	:	305-888-7257
Fax Number	:	786-635-1201

Authorized Official
Title or Position	:	OWNER
Name	:	DORIS VILLARREAL
Credential	:
Telephone Number	:	786-683-3586

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	11/25/2025

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Directions to “ADAM HOME #2, INC. ” Practice Location

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