Provider Demographics
NPI:1366610313
Name:SUNFLOWERS VILLAGE ALF INC.
Entity type:Organization
Organization Name:SUNFLOWERS VILLAGE ALF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-538-2902
Mailing Address - Street 1:8035 S.W. 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-266-9048
Mailing Address - Fax:
Practice Address - Street 1:8035 S.W. 13TH ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-266-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9575310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142622200Medicaid