1134337363 NPI number — LA ROSA ALF INC.

Table of content: (NPI 1134337363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134337363 NPI number — LA ROSA ALF INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA ROSA ALF INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134337363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7865 WEST 5 COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-982-8004
Provider Business Mailing Address Fax Number:
305-982-8004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7865 WEST 5 COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-982-8004
Provider Business Practice Location Address Fax Number:
305-982-8004
Provider Enumeration Date:
05/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
SEILIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-988-5619

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL 10145 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141729100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111170500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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