MEDICARE: SALMOS 23 NO. 7 LLC

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	8744	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1285467209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALMOS 23 NO. 7 LLC

Provider Business Mailing Address
First Line	:	1864 NW 175TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4840
Country	:	US
Telephone Number	:	305-264-4901
Fax Number	:	305-621-7990

Provider Business Practice Location Address
First Line	:	1864 NW 175TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4840
Country	:	US
Telephone Number	:	305-264-4901
Fax Number	:	305-621-7990

Authorized Official
Title or Position	:	OWNER
Name	:	ODELMYS BELLO
Credential	:
Telephone Number	:	305-264-4901

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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