Provider Demographics
NPI:1174858880
Name:FAIRWAY ALF INC
Entity Type:Organization
Organization Name:FAIRWAY ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-942-2799
Mailing Address - Street 1:15523 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1408
Mailing Address - Country:US
Mailing Address - Phone:786-285-1474
Mailing Address - Fax:305-704-8426
Practice Address - Street 1:15523 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1408
Practice Address - Country:US
Practice Address - Phone:786-285-1474
Practice Address - Fax:305-704-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11363310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility