Organization
MIMAS MEADOW HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYLEN OLIVA GONZALEZ (MGRM/OWNER)
(786) 537-9495
Entity
Organization
Contact information
Practice address
10162 SW 143RD PLACE, MIAMI, FL 33186-6987
(305) 456-3778
(305) 382-4119
Mailing address
10162 SW 143RD PLACE, MIAMI, FL 33186-6987
(305) 456-3778
(305) 382-4119
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10922
FL
Other
Enumeration date
10/20/2010
Last updated
11/02/2020
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