Provider Demographics
NPI:1114577376
Name:SANTA ANA ALF LLC
Entity Type:Organization
Organization Name:SANTA ANA ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ERESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-0965
Mailing Address - Street 1:11211 SW 188TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7528
Mailing Address - Country:US
Mailing Address - Phone:786-592-2339
Mailing Address - Fax:786-592-2339
Practice Address - Street 1:11211 SW 188TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-7528
Practice Address - Country:US
Practice Address - Phone:786-592-2339
Practice Address - Fax:786-592-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility