Provider Demographics
NPI:1982859591
Name:DIOS DA EL MANA
Entity Type:Organization
Organization Name:DIOS DA EL MANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREISDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-210-4938
Mailing Address - Street 1:9980 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1855
Mailing Address - Country:US
Mailing Address - Phone:786-210-4938
Mailing Address - Fax:305-226-3816
Practice Address - Street 1:9980 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1855
Practice Address - Country:US
Practice Address - Phone:786-210-4938
Practice Address - Fax:305-226-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11460310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility