MEDICARE: SENIOR PALACE 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	AL11426	FL

General Provider Information

NPI Number	:	1801048574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR PALACE ALF INC

Provider Business Mailing Address
First Line	:	4012 SW 154TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5442
Country	:	US
Telephone Number	:	786-337-0801
Fax Number	:	305-221-8653

Provider Business Practice Location Address
First Line	:	4012 SW 154TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5442
Country	:	US
Telephone Number	:	786-337-0801
Fax Number	:	305-221-8653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARMANDO MARTINEZ
Credential	:
Telephone Number	:	786-337-0801

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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