Provider Demographics
NPI:1669293965
Name:MI CASA SU CASA SENIORS VILLAS
Entity type:Organization
Organization Name:MI CASA SU CASA SENIORS VILLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:OTASHA
Authorized Official - Middle Name:SHEMIKA
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-860-1804
Mailing Address - Street 1:9039 NW 20TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6138
Mailing Address - Country:US
Mailing Address - Phone:954-344-0063
Mailing Address - Fax:754-229-8852
Practice Address - Street 1:9039 NW 20TH MNR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6138
Practice Address - Country:US
Practice Address - Phone:954-344-0063
Practice Address - Fax:754-229-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility