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
1	311ZA0620X	Adult Care Home Facility	6906350	FL

General Provider Information

NPI Number	:	1346674934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	1320 NW 171ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-5215
Country	:	US
Telephone Number	:	305-621-2269
Fax Number	:	305-621-2269

Provider Business Practice Location Address
First Line	:	1320 NW 171ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-5215
Country	:	US
Telephone Number	:	305-621-2269
Fax Number	:	305-621-2269

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CLAUDIA CHRISTINE ST.HILLAIRE
Credential	:	RN
Telephone Number	:	305-621-2269

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	08/30/2013

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