MEDICARE: ODALYS HOME, 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	9303	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	:	1326223215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODALYS HOME, INC

Provider Business Mailing Address
First Line	:	4342 SW 129TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4020
Country	:	US
Telephone Number	:	305-553-8701
Fax Number	:	305-553-8701

Provider Business Practice Location Address
First Line	:	4342 SW 129TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-4020
Country	:	US
Telephone Number	:	305-553-8701
Fax Number	:	305-553-8701

Authorized Official
Title or Position	:	OWNER
Name	:	LAZARO PEDROL
Credential	:
Telephone Number	:	305-979-6296

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	11/26/2024

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Directions to “ODALYS HOME, INC ” Practice Location

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