Provider Demographics
NPI:1114189438
Name:GENESIS ADUL CARE D/B/A AMOR DE DIOS (ALF)
Entity Type:Organization
Organization Name:GENESIS ADUL CARE D/B/A AMOR DE DIOS (ALF)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-485-1225
Mailing Address - Street 1:718 NW 132ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1810
Mailing Address - Country:US
Mailing Address - Phone:786-306-2610
Mailing Address - Fax:
Practice Address - Street 1:718 NW 132ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1810
Practice Address - Country:US
Practice Address - Phone:786-306-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10069310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility