Provider Demographics
NPI:1467634717
Name:CARPRICORN RETIREMENT HOME
Entity Type:Organization
Organization Name:CARPRICORN RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDRIDGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-688-4670
Mailing Address - Street 1:13720 NW 12TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168
Mailing Address - Country:US
Mailing Address - Phone:305-688-4670
Mailing Address - Fax:305-769-1262
Practice Address - Street 1:13720 NW 12TH AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:305-688-4670
Practice Address - Fax:305-769-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 7892310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility