MEDICARE: MI CASA HOMES LLC

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	12399	FL

General Provider Information

NPI Number	:	1740657675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI CASA HOMES LLC

Provider Business Mailing Address
First Line	:	6438 SW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3908
Country	:	US
Telephone Number	:	786-523-8898
Fax Number	:

Provider Business Practice Location Address
First Line	:	6438 SW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3908
Country	:	US
Telephone Number	:	786-523-8898
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALFREDO CABRERA
Credential	:
Telephone Number	:	786-523-8898

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	08/26/2015

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