Provider Demographics
NPI:1700174463
Name:MI CASITA ALF INC.
Entity Type:Organization
Organization Name:MI CASITA ALF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-328-0811
Mailing Address - Street 1:630 STALLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9206
Mailing Address - Country:US
Mailing Address - Phone:407-328-0811
Mailing Address - Fax:407-328-4850
Practice Address - Street 1:630 STALLINGS AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9206
Practice Address - Country:US
Practice Address - Phone:407-328-0811
Practice Address - Fax:407-328-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11911310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility