Provider Demographics
NPI:1396363735
Name:VILLA MIA ALF,INC
Entity Type:Organization
Organization Name:VILLA MIA ALF,INC
Other - Org Name:VILLA MIA ALF INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILCIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-240-7131
Mailing Address - Street 1:3321-23 SW 24TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-240-7131
Mailing Address - Fax:305-240-7131
Practice Address - Street 1:3321 SW 24TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3139
Practice Address - Country:US
Practice Address - Phone:305-240-7131
Practice Address - Fax:305-668-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility