Provider Demographics
NPI:1609037811
Name:MI VIEJO SOLALF CORP.
Entity Type:Organization
Organization Name:MI VIEJO SOLALF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BREIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-986-8104
Mailing Address - Street 1:4163 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6050
Mailing Address - Country:US
Mailing Address - Phone:305-224-4114
Mailing Address - Fax:
Practice Address - Street 1:4163 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6050
Practice Address - Country:US
Practice Address - Phone:305-224-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11191310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility