Provider Demographics
NPI:1629265566
Name:AMISTAD 308 INC
Entity type:Organization
Organization Name:AMISTAD 308 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-942-3537
Mailing Address - Street 1:8420 SW 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2006
Mailing Address - Country:US
Mailing Address - Phone:786-942-3537
Mailing Address - Fax:305-514-9161
Practice Address - Street 1:8420 SW 2ND STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2006
Practice Address - Country:US
Practice Address - Phone:786-942-3537
Practice Address - Fax:305-514-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142932900Medicaid