Provider Demographics
NPI:1821251729
Name:8715 NW 153 RD
Entity Type:Organization
Organization Name:8715 NW 153 RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-225-7119
Mailing Address - Street 1:8715 NW 153RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1356
Mailing Address - Country:US
Mailing Address - Phone:305-828-2003
Mailing Address - Fax:
Practice Address - Street 1:8715 NW 153RD TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1356
Practice Address - Country:US
Practice Address - Phone:305-828-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10764310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility