MEDICARE: NUESTRA CASA II 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	AL-12032	FL

General Provider Information

NPI Number	:	1710264916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUESTRA CASA II INC.

Provider Business Mailing Address
First Line	:	2832 GIULIANO AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3725
Country	:	US
Telephone Number	:	561-541-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 GIULIANO AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3725
Country	:	US
Telephone Number	:	561-541-1387
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TANIA LOPEZ
Credential	:
Telephone Number	:	561-541-1387

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	11/16/2011

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