MEDICARE: MI NUEVA VIDA ALF 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

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	:	1710519160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI NUEVA VIDA ALF INC.

Provider Business Mailing Address
First Line	:	403 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	786-313-3794
Fax Number	:	786-483-8978

Provider Business Practice Location Address
First Line	:	403 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	786-313-3794
Fax Number	:	786-483-8978

Authorized Official
Title or Position	:	OWNER
Name	:	ERICK FERNANDEZ
Credential	:
Telephone Number	:	305-525-8817

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	03/13/2023

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