Provider Demographics
NPI:1316117625
Name:VARADERO RETIREMENT HOME II, INC.
Entity type:Organization
Organization Name:VARADERO RETIREMENT HOME II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-812-8182
Mailing Address - Street 1:15372 SW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5233
Mailing Address - Country:US
Mailing Address - Phone:305-408-3660
Mailing Address - Fax:305-408-3660
Practice Address - Street 1:15372 SW 117TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5233
Practice Address - Country:US
Practice Address - Phone:305-408-3660
Practice Address - Fax:305-408-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11163310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility