Provider Demographics
NPI:1851525737
Name:CASA DULCE CORAZON, INC.
Entity Type:Organization
Organization Name:CASA DULCE CORAZON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER./ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-273-8332
Mailing Address - Street 1:11475 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6501
Mailing Address - Country:US
Mailing Address - Phone:305-971-8071
Mailing Address - Fax:
Practice Address - Street 1:11475 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6501
Practice Address - Country:US
Practice Address - Phone:305-971-8071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9827310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141844100Medicaid
FLAL9827OtherSTATE LICENSE