Provider Demographics
NPI:1275741142
Name:MARULY'S ADULT CARE, INC
Entity Type:Organization
Organization Name:MARULY'S ADULT CARE, INC
Other - Org Name:MARULY'S ADULT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-4898
Mailing Address - Street 1:12710 NW 8TH LANE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182
Mailing Address - Country:US
Mailing Address - Phone:305-300-4898
Mailing Address - Fax:305-221-0420
Practice Address - Street 1:311 SW 136TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184
Practice Address - Country:US
Practice Address - Phone:305-229-0396
Practice Address - Fax:305-221-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10215310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141821100Medicaid