Provider Demographics
NPI:1336447176
Name:FAMILY BOARDING HOME INC
Entity Type:Organization
Organization Name:FAMILY BOARDING HOME INC
Other - Org Name:PINES ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTED LIVING FACILITY ADM.
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTEGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-643-2571
Mailing Address - Street 1:1800 SW 11 TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135
Mailing Address - Country:US
Mailing Address - Phone:305-643-2571
Mailing Address - Fax:305-644-0091
Practice Address - Street 1:1800 SW 11TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5114
Practice Address - Country:US
Practice Address - Phone:305-643-2571
Practice Address - Fax:305-644-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5438310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140878000Medicaid