MEDICARE: OUR SWEET HOME CARE ALF CORP

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	AL9679	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174732283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR SWEET HOME CARE ALF CORP

Provider Business Mailing Address
First Line	:	2435 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2454
Country	:	US
Telephone Number	:	305-267-5404
Fax Number	:	305-225-1289

Provider Business Practice Location Address
First Line	:	2435 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2454
Country	:	US
Telephone Number	:	305-267-5404
Fax Number	:	305-225-1289

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERTO CASTANEDA
Credential	:
Telephone Number	:	305-267-5404

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/15/2008

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Directions to “OUR SWEET HOME CARE ALF CORP ” Practice Location

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