Provider Demographics
NPI:1801428297
Name:KENDALL HAVEN ALF LLC
Entity type:Organization
Organization Name:KENDALL HAVEN ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:DEMYS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-546-3036
Mailing Address - Street 1:13258 SW 62ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5651
Mailing Address - Country:US
Mailing Address - Phone:305-546-3036
Mailing Address - Fax:786-353-9149
Practice Address - Street 1:13258 SW 62ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5651
Practice Address - Country:US
Practice Address - Phone:305-546-3036
Practice Address - Fax:786-353-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility