MEDICARE: NEW GREENVIEW II 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	3104A0625X	Assisted Living Facility (Mental Illness)	AL11804	FL

General Provider Information

NPI Number	:	1538473376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GREENVIEW II INC

Provider Business Mailing Address
First Line	:	2650 NW 15TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-7652
Country	:	US
Telephone Number	:	305-225-7119
Fax Number	:	305-225-1289

Provider Business Practice Location Address
First Line	:	2650 NW 15TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-7652
Country	:	US
Telephone Number	:	305-225-7119
Fax Number	:	305-225-1289

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	JUAN C RIVEROL
Credential	:
Telephone Number	:	305-225-7119

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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