Provider Demographics
NPI:1083964753
Name:MAGGIES RETIREMENT HOME
Entity Type:Organization
Organization Name:MAGGIES RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARLABOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-6762
Mailing Address - Street 1:10975 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3521
Mailing Address - Country:US
Mailing Address - Phone:305-266-6762
Mailing Address - Fax:
Practice Address - Street 1:7930 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4314
Practice Address - Country:US
Practice Address - Phone:305-266-6762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5251310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL672994100Medicaid