Provider Demographics
NPI: | 1669677670 |
---|---|
Name: | YILLIAM HOME INC |
Entity Type: | Organization |
Organization Name: | YILLIAM HOME INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | YILLIAM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MORENO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-229-3431 |
Mailing Address - Street 1: | 13888 SW 18TH TER |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33175-7519 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-229-3431 |
Mailing Address - Fax: | 305-223-1618 |
Practice Address - Street 1: | 13888 SW 18TH TER |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33175-7519 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-229-3431 |
Practice Address - Fax: | 305-223-1618 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-19 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | AL10074 | 3104A0625X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |