Provider Demographics
NPI:1518530849
Name:MARY'S HOUSE ALF, LLC
Entity Type:Organization
Organization Name:MARY'S HOUSE ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:786-486-7673
Mailing Address - Street 1:7002 SW 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4323
Mailing Address - Country:US
Mailing Address - Phone:786-486-7673
Mailing Address - Fax:
Practice Address - Street 1:9191 STERLING DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7016
Practice Address - Country:US
Practice Address - Phone:786-732-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility