MEDICARE: CORAL REEF RESIDENTIAL CARE 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

General Provider Information

NPI Number	:	1841065380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL REEF RESIDENTIAL CARE LLC

Provider Business Mailing Address
First Line	:	6961 PARK ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3833
Country	:	US
Telephone Number	:	786-354-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	18530 NW 22ND CT
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3213
Country	:	US
Telephone Number	:	786-354-5490
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARIAN OJEDA GARCIA
Credential	:
Telephone Number	:	786-354-5490

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/17/2023

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