Provider Demographics
NPI:1447996335
Name:CARE & LOVE RETIREMENT HOME LLC.
Entity type:Organization
Organization Name:CARE & LOVE RETIREMENT HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-454-8808
Mailing Address - Street 1:642 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4020
Mailing Address - Country:US
Mailing Address - Phone:305-454-8808
Mailing Address - Fax:877-912-5424
Practice Address - Street 1:642 E 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4020
Practice Address - Country:US
Practice Address - Phone:305-454-8808
Practice Address - Fax:877-912-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113675300Medicaid