Provider Demographics
NPI:1073744231
Name:JOSHUA NEW LIFE CORP
Entity Type:Organization
Organization Name:JOSHUA NEW LIFE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-256-9902
Mailing Address - Street 1:18309 SW 114TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4989
Mailing Address - Country:US
Mailing Address - Phone:305-256-9902
Mailing Address - Fax:786-219-3245
Practice Address - Street 1:18309 SW 114TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-4989
Practice Address - Country:US
Practice Address - Phone:305-256-9902
Practice Address - Fax:786-219-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11622310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility