MEDICARE: 840 SW 8TH 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

General Provider Information

NPI Number	:	1417674714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	840 SW 8TH LLC

Provider Business Mailing Address
First Line	:	10001 W OAKLAND PARK BLVD STE 302
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-6925
Country	:	US
Telephone Number	:	855-331-6615
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 SW 8TH ST
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-8214
Country	:	US
Telephone Number	:	855-331-6615
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANDRES DUARTES
Credential	:
Telephone Number	:	305-409-0949

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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