Provider Demographics
NPI:1851536882
Name:MIAMI LAKES SENIOR CARE, INC.
Entity Type:Organization
Organization Name:MIAMI LAKES SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAMATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-934-8770
Mailing Address - Street 1:6791 ROYAL MELBOURNE DR.
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-934-8770
Mailing Address - Fax:305-816-9996
Practice Address - Street 1:16350 N. W. 88TH PATH
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-934-8770
Practice Address - Fax:305-816-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10508310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid