MEDICARE: CASA AMOR 2 ALF 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

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	:	1629735485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA AMOR 2 ALF LLC

Provider Business Mailing Address
First Line	:	2461 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6518
Country	:	US
Telephone Number	:	786-953-5244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6518
Country	:	US
Telephone Number	:	786-953-5244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAYSIX LLERA
Credential	:
Telephone Number	:	786-953-5244

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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