MEDICARE: LAS PALMAS ALF CORP.

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	:	1861849770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS PALMAS ALF CORP.

Provider Business Mailing Address
First Line	:	4495 NW 185 SREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33055
Country	:	US
Telephone Number	:	305-634-2851
Fax Number	:	305-634-2851

Provider Business Practice Location Address
First Line	:	4495 NW 185 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33055
Country	:	US
Telephone Number	:	305-634-2851
Fax Number	:	305-634-2851

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RAUL PEREZ
Credential	:
Telephone Number	:	786-290-1032

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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Directions to “LAS PALMAS ALF CORP. ” Practice Location

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