Provider Demographics
NPI:1629793559
Name:PRIME TIME ALF NETWORK LLC
Entity Type:Organization
Organization Name:PRIME TIME ALF NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLAING
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-801-1133
Mailing Address - Street 1:1105 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3802
Mailing Address - Country:US
Mailing Address - Phone:305-801-1133
Mailing Address - Fax:
Practice Address - Street 1:1105 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3802
Practice Address - Country:US
Practice Address - Phone:305-801-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility