Provider Demographics
NPI:1568824746
Name:M. D. RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:M. D. RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-1239
Mailing Address - Street 1:13920 SW 71ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2112
Mailing Address - Country:US
Mailing Address - Phone:305-386-4259
Mailing Address - Fax:305-386-4259
Practice Address - Street 1:13920 SW 71ST LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2112
Practice Address - Country:US
Practice Address - Phone:305-386-4259
Practice Address - Fax:305-386-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility