MEDICARE: MI SUBLIME ATARDECER, 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

General Provider Information

NPI Number	:	1245499631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI SUBLIME ATARDECER, INC

Provider Business Mailing Address
First Line	:	20630 NW 37 CT.
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055
Country	:	US
Telephone Number	:	305-760-2653
Fax Number	:	305-628-6158

Provider Business Practice Location Address
First Line	:	20630 NW 37 CT.
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055
Country	:	US
Telephone Number	:	305-760-2653
Fax Number	:	305-628-6158

Authorized Official
Title or Position	:	OWNER
Name	:	PEDRO A ROMANACH LEIVA
Credential	:
Telephone Number	:	786-547-3749

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	12/17/2025

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