MEDICARE: MAYLU RETIREMENT HOME, 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	3104A0625X	Assisted Living Facility (Mental Illness)	7716	FL
2	310400000X	Assisted Living Facility	7716	FL

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	:	1780887042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYLU RETIREMENT HOME, INC.

Provider Business Mailing Address
First Line	:	4751 NW 4TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2115
Country	:	US
Telephone Number	:	305-445-0380
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 NW 4TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2115
Country	:	US
Telephone Number	:	305-445-0380
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANIBAL MORGADO
Credential	:
Telephone Number	:	305-445-0380

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	02/08/2012

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