MEDICARE: WEST MIAMI ADULT LIVING FACILITY, 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	AL10925	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	:	1871749077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST MIAMI ADULT LIVING FACILITY, INC

Provider Business Mailing Address
First Line	:	7215 SW 21ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1472
Country	:	US
Telephone Number	:	305-300-7721
Fax Number	:	305-223-2371

Provider Business Practice Location Address
First Line	:	7215 SW 21ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1472
Country	:	US
Telephone Number	:	305-300-7721
Fax Number	:	305-223-2371

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	BELKIS VILLALBA
Credential	:
Telephone Number	:	305-300-7721

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	08/07/2008

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