Provider Demographics
NPI:1497349450
Name:SAINT JOHNS ALF LLC
Entity Type:Organization
Organization Name:SAINT JOHNS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-218-5178
Mailing Address - Street 1:7580 SW 30TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2750
Mailing Address - Country:US
Mailing Address - Phone:786-360-2940
Mailing Address - Fax:786-615-5676
Practice Address - Street 1:7580 SW 30TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2750
Practice Address - Country:US
Practice Address - Phone:786-360-2940
Practice Address - Fax:786-615-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL13562OtherAHCA