MEDICARE: MIMI'S ALF # 2

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	AL7838	FL

General Provider Information

NPI Number	:	1710196001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMI'S ALF # 2

Provider Business Mailing Address
First Line	:	10790 SW 43RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4835
Country	:	US
Telephone Number	:	305-227-5438
Fax Number	:	305-225-1289

Provider Business Practice Location Address
First Line	:	10790 SW 43RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4835
Country	:	US
Telephone Number	:	305-227-5438
Fax Number	:	305-225-1289

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DANIA ROMERO
Credential	:
Telephone Number	:	305-227-5438

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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