Provider Demographics
NPI:1396326690
Name:ANGELES DE VIDA ALF CORP
Entity type:Organization
Organization Name:ANGELES DE VIDA ALF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEYDIS
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-3574
Mailing Address - Street 1:11263 SW 35TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3409
Mailing Address - Country:US
Mailing Address - Phone:786-312-3574
Mailing Address - Fax:
Practice Address - Street 1:11263 SW 35TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3409
Practice Address - Country:US
Practice Address - Phone:786-312-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12755Medicaid