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NPI Code Detail

MEDICARE: ADULT FAMILY CARE HOME

MEDICARE: ADULT FAMILY CARE HOME
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
1311ZA0620XAdult Care Home Facility110340FL

General Provider Information

NPI Number : 1306099742
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADULT FAMILY CARE HOME
Provider Business Mailing Address
First Line : 50 NW 184TH TER
Second Line :
City : MIAMI
State : FL
Zip : 33169-4512
Country : US
Telephone Number : 305-653-4436
Fax Number :
Provider Business Practice Location Address
First Line : 50 NW 184TH TER
Second Line :
City : MIAMI
State : FL
Zip : 33169-4512
Country : US
Telephone Number : 305-653-4436
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR/OWNER
Name : MRS. MURTLE SUCKIE
Credential :
Telephone Number : 305-653-4436
Provider Enumeration Date : 10/29/2008
Last Update Date : 04/08/2009

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Directions to “ADULT FAMILY CARE HOME ” Practice Location

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