Provider Demographics
NPI:1568824381
Name:NONNA GLORIA ALF, INC.
Entity Type:Organization
Organization Name:NONNA GLORIA ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:MILEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-3329
Mailing Address - Street 1:12748 N.W. 98 CT.
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1331
Mailing Address - Country:US
Mailing Address - Phone:305-820-3329
Mailing Address - Fax:305-820-3329
Practice Address - Street 1:12748 NW 98TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-7422
Practice Address - Country:US
Practice Address - Phone:305-820-3329
Practice Address - Fax:305-820-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10339310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility