MEDICARE: PRIME TIME ALF NETWORK 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

General Provider Information

NPI Number	:	1629793559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME TIME ALF NETWORK LLC

Provider Business Mailing Address
First Line	:	1105 W 2ND AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3802
Country	:	US
Telephone Number	:	305-801-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 W 2ND AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3802
Country	:	US
Telephone Number	:	305-801-1133
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CAROLAING FERNANDEZ RAMIREZ
Credential	:
Telephone Number	:	305-801-1133

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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