Provider Demographics
NPI:1891541645
Name:LIVING THE DREAM ALF LLC
Entity type:Organization
Organization Name:LIVING THE DREAM ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-910-9465
Mailing Address - Street 1:13442 SW 284TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1942
Mailing Address - Country:US
Mailing Address - Phone:786-601-7385
Mailing Address - Fax:786-601-7385
Practice Address - Street 1:13442 SW 284TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1942
Practice Address - Country:US
Practice Address - Phone:786-601-7385
Practice Address - Fax:786-601-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12831OtherAHCA