Provider Demographics
NPI:1871749077
Name:WEST MIAMI ADULT LIVING FACILITY, INC
Entity type:Organization
Organization Name:WEST MIAMI ADULT LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-7721
Mailing Address - Street 1:7215 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1472
Mailing Address - Country:US
Mailing Address - Phone:305-300-7721
Mailing Address - Fax:305-223-2371
Practice Address - Street 1:7215 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1472
Practice Address - Country:US
Practice Address - Phone:305-300-7721
Practice Address - Fax:305-223-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10925310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142758000Medicaid