Provider Demographics
NPI:1629231741
Name:RESIDENTIAL HOME FOR ADULT CARE I, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL HOME FOR ADULT CARE I, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:URRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-796-0361
Mailing Address - Street 1:1535 N.W. 25 AVE.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-633-9106
Mailing Address - Fax:305-644-2113
Practice Address - Street 1:1535 N.W. 25 AVE.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-633-9106
Practice Address - Fax:305-644-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility