Provider Demographics
NPI:1518195874
Name:SOUTH MIAMI HEALTH FACILITY, INC.
Entity Type:Organization
Organization Name:SOUTH MIAMI HEALTH FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SISI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-661-4204
Mailing Address - Street 1:7650 SW 64TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4614
Mailing Address - Country:US
Mailing Address - Phone:305-661-4204
Mailing Address - Fax:
Practice Address - Street 1:7650 SW 64TH CT
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4614
Practice Address - Country:US
Practice Address - Phone:305-661-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9650310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility