Provider Demographics
NPI:1043419716
Name:HOGAR DE AMABLE CONSUELO CORPORATION
Entity Type:Organization
Organization Name:HOGAR DE AMABLE CONSUELO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-1577
Mailing Address - Street 1:134 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2624
Mailing Address - Country:US
Mailing Address - Phone:305-822-5752
Mailing Address - Fax:
Practice Address - Street 1:134 W 59TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2624
Practice Address - Country:US
Practice Address - Phone:305-822-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8745310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140426100Medicaid