Provider Demographics
NPI:1336350297
Name:RAFFA CORP
Entity Type:Organization
Organization Name:RAFFA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-210-2595
Mailing Address - Street 1:15032 SW 55 TERR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:786-401-6319
Mailing Address - Fax:786-536-5503
Practice Address - Street 1:15032 SW 55 TERR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:786-401-6319
Practice Address - Fax:786-536-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-09-13
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2018-07-31
Provider Licenses
StateLicense IDTaxonomies
FLAL 10271310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141882300Medicaid
FL685806600Medicaid