Provider Demographics
NPI:1598111460
Name:HERMANOS VAZQUEZ ALF CORP.
Entity Type:Organization
Organization Name:HERMANOS VAZQUEZ ALF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-401-7846
Mailing Address - Street 1:15578 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2417
Mailing Address - Country:US
Mailing Address - Phone:786-401-7846
Mailing Address - Fax:786-401-7846
Practice Address - Street 1:15578 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2417
Practice Address - Country:US
Practice Address - Phone:786-401-7846
Practice Address - Fax:786-401-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12825310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility