Provider Demographics
NPI:1790010999
Name:SUPERIOR LIVING OF HIALEAH, INC
Entity Type:Organization
Organization Name:SUPERIOR LIVING OF HIALEAH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-586-6005
Mailing Address - Street 1:70 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2732
Mailing Address - Country:US
Mailing Address - Phone:305-888-0779
Mailing Address - Fax:305-888-8970
Practice Address - Street 1:70 E 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2732
Practice Address - Country:US
Practice Address - Phone:305-888-0779
Practice Address - Fax:305-888-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness