MEDICARE: LAS PALMAS ALF

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	:	1639409881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS PALMAS ALF

Provider Business Mailing Address
First Line	:	4495 NW 185TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3079
Country	:	US
Telephone Number	:	305-586-8786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4495 NW 185TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3079
Country	:	US
Telephone Number	:	305-586-8786
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. EMERITA SANTAMARIA
Credential	:
Telephone Number	:	305-586-8786

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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Directions to “LAS PALMAS ALF ” Practice Location

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