MEDICARE: HOGAR DE ABUELOS

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	AL11358	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	:	1245566884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGAR DE ABUELOS

Provider Business Mailing Address
First Line	:	3240 NW 18TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1838
Country	:	US
Telephone Number	:	305-635-2893
Fax Number	:

Provider Business Practice Location Address
First Line	:	3240 NW 18TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1838
Country	:	US
Telephone Number	:	305-635-2893
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ARNALDO QUINTERO
Credential	:
Telephone Number	:	305-635-2893

Provider Enumeration Date	:	11/01/2009
Last Update Date	:	11/01/2009

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Directions to “HOGAR DE ABUELOS ” Practice Location

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