MEDICARE: SENIOR RETIREMENT HOME

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	AL7813	FL

General Provider Information

NPI Number	:	1710175435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR RETIREMENT HOME

Provider Business Mailing Address
First Line	:	3033 SW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2734
Country	:	US
Telephone Number	:	305-541-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 SW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2734
Country	:	US
Telephone Number	:	305-541-4336
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MARIA TERESA GUERRERO
Credential	:
Telephone Number	:	305-305-8711

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	06/03/2008

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