MEDICARE: GARDEN VALLEY RETIREMENT HOME 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	AL11388	FL

General Provider Information

NPI Number	:	1336398296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN VALLEY RETIREMENT HOME LLC.

Provider Business Mailing Address
First Line	:	15341 SW 20TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4379
Country	:	US
Telephone Number	:	305-300-1577
Fax Number	:	305-779-6968

Provider Business Practice Location Address
First Line	:	18140 NW 90TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-6555
Country	:	US
Telephone Number	:	305-300-1577
Fax Number	:	305-779-6968

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECCA CAIRO
Credential	:
Telephone Number	:	305-300-1577

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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