Provider Demographics
NPI:1760640122
Name:BERMUDEZ SENIOR CARE, INC
Entity Type:Organization
Organization Name:BERMUDEZ SENIOR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYENCYS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-227-2661
Mailing Address - Street 1:5301 SW 162ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5045
Mailing Address - Country:US
Mailing Address - Phone:305-227-2661
Mailing Address - Fax:305-227-2551
Practice Address - Street 1:5301 SW 162ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5045
Practice Address - Country:US
Practice Address - Phone:305-227-2661
Practice Address - Fax:305-227-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11117310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142884500Medicaid
FL693049200Medicaid