Provider Demographics
NPI:1164822136
Name:PIPO JR ALF INC
Entity Type:Organization
Organization Name:PIPO JR ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-447-0716
Mailing Address - Street 1:9860 CARIBBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1572
Mailing Address - Country:US
Mailing Address - Phone:305-971-9667
Mailing Address - Fax:305-971-9667
Practice Address - Street 1:9860 CARIBBEAN BLVD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1572
Practice Address - Country:US
Practice Address - Phone:305-971-9667
Practice Address - Fax:305-971-9667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIPO JR ALF INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10803310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012646300Medicaid