MEDICARE: CASANOVA ALF #3

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	AL9749	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	:	1477760957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASANOVA ALF #3

Provider Business Mailing Address
First Line	:	2461 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6518
Country	:	US
Telephone Number	:	305-557-5620
Fax Number	:	305-231-9212

Provider Business Practice Location Address
First Line	:	2461 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6518
Country	:	US
Telephone Number	:	305-557-5620
Fax Number	:	305-231-9212

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NORMA ALICIA CASANOVA
Credential	:	ADMON
Telephone Number	:	305-343-9971

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	05/30/2008

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