Provider Demographics
NPI:1285805168
Name:IVES DAIRY SENIOR CARE, INC.
Entity type:Organization
Organization Name:IVES DAIRY SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANACAONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENISES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-316-6007
Mailing Address - Street 1:19840 NE 10TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3554
Mailing Address - Country:US
Mailing Address - Phone:786-316-6007
Mailing Address - Fax:
Practice Address - Street 1:19840 NE 10TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3554
Practice Address - Country:US
Practice Address - Phone:786-316-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11259310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL143020300Medicaid