Provider Demographics
NPI:1740870369
Name:MUNDI HOME LLC
Entity type:Organization
Organization Name:MUNDI HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-219-7622
Mailing Address - Street 1:9970 SW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3938
Mailing Address - Country:US
Mailing Address - Phone:786-703-1616
Mailing Address - Fax:786-637-2466
Practice Address - Street 1:9970 SW 38TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3938
Practice Address - Country:US
Practice Address - Phone:786-703-1616
Practice Address - Fax:786-637-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL13546OtherAHCA