Provider Demographics
NPI:1124284070
Name:MY KIND HOME ALF
Entity type:Organization
Organization Name:MY KIND HOME ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-348-9405
Mailing Address - Street 1:1846 SW 22ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3822
Mailing Address - Country:US
Mailing Address - Phone:786-348-9405
Mailing Address - Fax:305-828-1511
Practice Address - Street 1:1846 SW 22ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3822
Practice Address - Country:US
Practice Address - Phone:786-348-9405
Practice Address - Fax:305-828-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10486310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL143041600Medicaid