Organization
ST. MARY ADULT CARE
Active
Other names
ST. MARY ADULT CARE II
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ELENA FERNANDEZ (OWNER/ ADMINISTRATOR)
(786) 393-8122
Entity
Organization
Contact information
Practice address
11271 SW 229TH TER, MIAMI, FL 33170-7563
(786) 504-2397
(305) 408-1263
Mailing address
PO BOX 771120, MIAMI, FL 33177-0019
(786) 393-8122
(305) 408-1263
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL11069
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142850100
—
FL
05
—
692848000
—
FL
Enumeration date
02/12/2008
Last updated
02/19/2014
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