MEDICARE: KEKO JONES INVESTMENT

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL44	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	:	1326241761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEKO JONES INVESTMENT

Provider Business Mailing Address
First Line	:	1045 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4008
Country	:	US
Telephone Number	:	305-883-8376
Fax Number	:	305-883-4760

Provider Business Practice Location Address
First Line	:	1045 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4008
Country	:	US
Telephone Number	:	305-883-8376
Fax Number	:	305-883-4760

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LUIS ENRIQUE COLLAZO
Credential	:	MSW
Telephone Number	:	305-733-5199

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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