Organization
LA GLORIA DE DIOS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAZARA Y MONTANA (OWNER)
(786) 547-3556
Entity
Organization
Contact information
Practice address
3456 SW 113TH PL, MIAMI, FL 33165-3414
(786) 362-5868
(786) 362-5868
Mailing address
3456 SW 113TH PL, MIAMI, FL 33165-3414
(786) 362-5868
(786) 362-5868
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13668
AHCA
FL
Enumeration date
12/14/2021
Last updated
12/14/2021
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