Organization
MOONSHINE ALF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARMANDO FANDINO ESPINOSA (OWNER)
(786) 691-6809
Entity
Organization
Contact information
Practice address
19240 SW 124TH CT, MIAMI, FL 33177-6500
(305) 278-7314
(786) 244-5787
Mailing address
19240 SW 124TH CT, MIAMI, FL 33177-6500
(305) 278-7314
(786) 244-5787
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9350
AHCA
FL
Enumeration date
04/04/2023
Last updated
04/04/2023
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