MEDICARE: LAUGH TO LIVE ALF 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

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	:	1144866682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUGH TO LIVE ALF INC

Provider Business Mailing Address
First Line	:	8635 SW 207TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3836
Country	:	US
Telephone Number	:	305-720-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 SW 207TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3836
Country	:	US
Telephone Number	:	305-720-1870
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ELISA LEYVA
Credential	:
Telephone Number	:	305-720-1870

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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