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Organization
VIDA NUEVA #1 CORP.
Active
Organization
VIDA NUEVA #1 CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN GONZALEZ (ADMINISTRATOR)
(786) 312-4259
Entity
Organization
Contact information
Practice address
745 N.W. 102 ST., MIAMI, FL 33150
(305) 758-1629
(305) 758-1958
Mailing address
745 N.W. 102 ST., MIAMI, FL 33150
(305) 758-1629
(305) 758-1958
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10840
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001988309
—
FL
Enumeration date
08/05/2010
Last updated
06/11/2019
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