MEDICARE: MYRTLES RETIREMENT HOME

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	113040	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	:	1811411341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRTLES RETIREMENT HOME

Provider Business Mailing Address
First Line	:	50 NW 184TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-4512
Country	:	US
Telephone Number	:	305-653-4436
Fax Number	:	305-465-3443

Provider Business Practice Location Address
First Line	:	50 NW 184TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-4512
Country	:	US
Telephone Number	:	305-653-4436
Fax Number	:	305-465-3443

Authorized Official
Title or Position	:	OWNER
Name	:	MYRTLE SUCKIE
Credential	:
Telephone Number	:	305-653-4436

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/21/2022

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Directions to “MYRTLES RETIREMENT HOME ” Practice Location

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