Provider Demographics
NPI:1376967604
Name:SAN JUDAS LOVE AND CARE INC
Entity Type:Organization
Organization Name:SAN JUDAS LOVE AND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-2003
Mailing Address - Street 1:17715 NW 87TH CT
Mailing Address - Street 2:NW
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6604
Mailing Address - Country:US
Mailing Address - Phone:305-828-2003
Mailing Address - Fax:305-556-1118
Practice Address - Street 1:17715 NW 87TH CT
Practice Address - Street 2:NW
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6604
Practice Address - Country:US
Practice Address - Phone:305-828-2003
Practice Address - Fax:305-556-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10450310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility