Provider Demographics
NPI:1316728983
Name:AVE FENIX ALF LLC
Entity type:Organization
Organization Name:AVE FENIX ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:NURYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-715-1839
Mailing Address - Street 1:10120 CARIBBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1526
Mailing Address - Country:US
Mailing Address - Phone:786-250-4456
Mailing Address - Fax:786-250-4456
Practice Address - Street 1:10120 CARIBBEAN BLVD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1526
Practice Address - Country:US
Practice Address - Phone:786-250-4456
Practice Address - Fax:786-250-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13833OtherAHCA