Provider Demographics
NPI:1407522881
Name:MAGIK ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MAGIK ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-273-8975
Mailing Address - Street 1:1315 SE 9TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5907
Mailing Address - Country:US
Mailing Address - Phone:786-273-8975
Mailing Address - Fax:305-675-7668
Practice Address - Street 1:1315 SE 9 AVENUE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5907
Practice Address - Country:US
Practice Address - Phone:786-273-8975
Practice Address - Fax:305-675-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111504900Medicaid