Organization
COUNTRY CLUB LIVING , INC.
Active
Other names
MIAMI LAKES RETIREMENT HOME
Organization subpart
No
Provider details
NPI number
Authorized official
YENEY SUAREZ I (OWNER)
(786) 715-8902
Entity
Organization
Contact information
Practice address
16837 N. W. 91 CT., MIAMI LAKES, FL 33018
(305) 549-8657
(305) 816-9996
Mailing address
16837 N. W. 91 CT., MIAMI LAKES, FL 33018
(305) 549-8657
(305) 816-9996
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10449
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142170100
—
FL
05
—
689009100
—
FL
Enumeration date
04/09/2007
Last updated
01/27/2023
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