Provider Demographics
NPI:1073803052
Name:PEACE & CARE OF MIAMI LAKES
Entity Type:Organization
Organization Name:PEACE & CARE OF MIAMI LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GIPSY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONTELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-450-9457
Mailing Address - Street 1:15301 DURNFORD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15301 DURNFORD DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2319
Practice Address - Country:US
Practice Address - Phone:305-450-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11968310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11968OtherLICENSE NUMBER