MEDICARE: PERNAS GROUP HOME 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1669880480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERNAS GROUP HOME INC.

Provider Business Mailing Address
First Line	:	1036 NW 11TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2912
Country	:	US
Telephone Number	:	786-389-3808
Fax Number	:	305-545-5605

Provider Business Practice Location Address
First Line	:	1036 NW 11TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2912
Country	:	US
Telephone Number	:	786-389-3808
Fax Number	:	305-545-5605

Authorized Official
Title or Position	:	OWNER
Name	:	NEFTALI PERNAS
Credential	:
Telephone Number	:	786-389-3808

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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