Provider Demographics
NPI:1720704661
Name:MARY FAMILY HOME LLC
Entity Type:Organization
Organization Name:MARY FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SABINA MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-909-0208
Mailing Address - Street 1:7935 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2942
Mailing Address - Country:US
Mailing Address - Phone:305-385-1138
Mailing Address - Fax:305-385-1138
Practice Address - Street 1:7935 SW 146TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2942
Practice Address - Country:US
Practice Address - Phone:305-385-1138
Practice Address - Fax:305-385-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7174OtherAHCA