Provider Demographics
NPI:1558790170
Name:ANNIE HORNE ALF
Entity Type:Organization
Organization Name:ANNIE HORNE ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-681-6773
Mailing Address - Street 1:17020 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4265
Mailing Address - Country:US
Mailing Address - Phone:305-626-9829
Mailing Address - Fax:305-626-9829
Practice Address - Street 1:17020 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4265
Practice Address - Country:US
Practice Address - Phone:305-626-9829
Practice Address - Fax:305-626-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL107513104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness