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Organization
OLD DOMINIUM, INC
Active
Organization
OLD DOMINIUM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE LUIS SOSA (ADMINISTRATOR)
(305) 219-9445
Entity
Organization
Contact information
Practice address
9820 SW 72ND ST, MIAMI, FL 33173-4618
(305) 219-9445
Mailing address
9820 SW 72ND ST, MIAMI, FL 33173-4618
(305) 219-9445
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL11130
FL
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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