Provider Demographics
NPI:1780894865
Name:ROYAL GREEN ALF INC
Entity type:Organization
Organization Name:ROYAL GREEN ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-643-9786
Mailing Address - Street 1:2011 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1811
Mailing Address - Country:US
Mailing Address - Phone:305-643-9786
Mailing Address - Fax:305-225-1289
Practice Address - Street 1:2011 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1811
Practice Address - Country:US
Practice Address - Phone:305-643-9786
Practice Address - Fax:305-225-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-08-04
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-07
Provider Licenses
StateLicense IDTaxonomies
FLAL 10020310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140946800Medicaid