MEDICARE: NORLAND GARDENS 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		FL

General Provider Information

NPI Number	:	1437459377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORLAND GARDENS INC,

Provider Business Mailing Address
First Line	:	19615 NW 12TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-3080
Country	:	US
Telephone Number	:	305-653-0918
Fax Number	:	305-653-1720

Provider Business Practice Location Address
First Line	:	19615 NW 12TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-3080
Country	:	US
Telephone Number	:	305-653-0918
Fax Number	:	305-653-1720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. EUFRACIA URENA
Credential	:	RN
Telephone Number	:	305-653-0918

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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