Provider Demographics
NPI:1639631054
Name:MICASA ALF LLC
Entity Type:Organization
Organization Name:MICASA ALF LLC
Other - Org Name:MICASA SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-646-1212
Mailing Address - Street 1:6920 SW 56TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7004
Mailing Address - Country:US
Mailing Address - Phone:954-613-1163
Mailing Address - Fax:
Practice Address - Street 1:6021 DUVAL ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7961
Practice Address - Country:US
Practice Address - Phone:954-613-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106326300Medicaid
FLAL13462OtherLICENSE