MEDICARE: MERCY & MICHAEL ALF, 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	310400000X	Assisted Living Facility	11389	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	:	1457584393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY & MICHAEL ALF, INC

Provider Business Mailing Address
First Line	:	3000-3002 SW 23 TERRACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	786-295-5920
Fax Number	:	305-207-2379

Provider Business Practice Location Address
First Line	:	3000-3002 SW 23 TERRACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	786-295-5920
Fax Number	:	305-207-2379

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. AGUSTINA R RODRIGUEZ
Credential	:
Telephone Number	:	786-295-5920

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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