Provider Demographics
NPI:1336398296
Name:GARDEN VALLEY RETIREMENT HOME LLC.
Entity Type:Organization
Organization Name:GARDEN VALLEY RETIREMENT HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-1577
Mailing Address - Street 1:15341 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4379
Mailing Address - Country:US
Mailing Address - Phone:305-300-1577
Mailing Address - Fax:305-779-6968
Practice Address - Street 1:18140 NW 90TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6555
Practice Address - Country:US
Practice Address - Phone:305-300-1577
Practice Address - Fax:305-779-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11388310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility