Provider Demographics
NPI:1275743312
Name:TADEOS ALF CORP
Entity Type:Organization
Organization Name:TADEOS ALF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-317-6505
Mailing Address - Street 1:1525 SW 119TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184
Mailing Address - Country:US
Mailing Address - Phone:305-221-4905
Mailing Address - Fax:
Practice Address - Street 1:1525 SW 119TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184
Practice Address - Country:US
Practice Address - Phone:305-221-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680283400Medicaid
FL140000200Medicaid