MEDICARE: PARADISE AT MILLER, 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	AL11153	FL

General Provider Information

NPI Number	:	1861663957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE AT MILLER, INC

Provider Business Mailing Address
First Line	:	16234 SW 54TH TERRACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5107
Country	:	US
Telephone Number	:	305-226-6099
Fax Number	:	305-223-2371

Provider Business Practice Location Address
First Line	:	16234 SW 54TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5004
Country	:	US
Telephone Number	:	305-226-6099
Fax Number	:	305-223-2371

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARIA N MIRABAL
Credential	:
Telephone Number	:	305-226-6099

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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