Provider Demographics
NPI:1346953817
Name:FAIRLAWNS ALF LLC
Entity Type:Organization
Organization Name:FAIRLAWNS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DYNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-335-5105
Mailing Address - Street 1:911 NW 198TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3012
Mailing Address - Country:US
Mailing Address - Phone:305-653-8465
Mailing Address - Fax:305-653-8465
Practice Address - Street 1:911 NW 198TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3012
Practice Address - Country:US
Practice Address - Phone:305-653-8465
Practice Address - Fax:305-653-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13762OtherAHCA