Provider Demographics
NPI:1649416561
Name:MISTER AMADEO RETIREMENT HOME INC,
Entity Type:Organization
Organization Name:MISTER AMADEO RETIREMENT HOME INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:
Authorized Official - First Name:LEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-351-0474
Mailing Address - Street 1:3625 NW 12 TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2847
Mailing Address - Country:US
Mailing Address - Phone:305-631-0574
Mailing Address - Fax:305-290-3706
Practice Address - Street 1:3625 NW 12 TERRACE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2847
Practice Address - Country:US
Practice Address - Phone:305-631-0574
Practice Address - Fax:305-290-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11451310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000800900Medicaid