Provider Demographics
NPI:1760783195
Name:CASA DE PAZ ALF, INC.
Entity Type:Organization
Organization Name:CASA DE PAZ ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ARMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-778-6776
Mailing Address - Street 1:9360 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8114
Mailing Address - Country:US
Mailing Address - Phone:305-223-0821
Mailing Address - Fax:305-372-0408
Practice Address - Street 1:9360 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8114
Practice Address - Country:US
Practice Address - Phone:305-223-0821
Practice Address - Fax:305-372-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10991310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142804700Medicaid