Provider Demographics
NPI:1437585270
Name:LOS TRES MILAGROS II, LLC
Entity Type:Organization
Organization Name:LOS TRES MILAGROS II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-610-8113
Mailing Address - Street 1:15431 SW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-5409
Mailing Address - Country:US
Mailing Address - Phone:305-964-5789
Mailing Address - Fax:786-373-0112
Practice Address - Street 1:15431 SW 159TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-5409
Practice Address - Country:US
Practice Address - Phone:305-234-7246
Practice Address - Fax:305-489-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12398310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility