MEDICARE: VINALES ALF, 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	12733	FL

General Provider Information

NPI Number	:	1902270325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINALES ALF, INC.

Provider Business Mailing Address
First Line	:	14336 SW 172ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2736
Country	:	US
Telephone Number	:	305-454-8306
Fax Number	:	305-454-8306

Provider Business Practice Location Address
First Line	:	14336 SW 172ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2736
Country	:	US
Telephone Number	:	305-454-8306
Fax Number	:	305-454-8306

Authorized Official
Title or Position	:	OWNER/ADMIN.
Name	:	JUAN ACOSTA
Credential	:
Telephone Number	:	305-454-8306

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	11/23/2015

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