Provider Demographics
NPI:1952566770
Name:NUEVITAS HOME FOR THE ELDERLY INC 2
Entity Type:Organization
Organization Name:NUEVITAS HOME FOR THE ELDERLY INC 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-547-9240
Mailing Address - Street 1:675 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3336
Mailing Address - Country:US
Mailing Address - Phone:305-696-9392
Mailing Address - Fax:
Practice Address - Street 1:675 E 31ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3336
Practice Address - Country:US
Practice Address - Phone:305-696-9392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9653310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140656600Medicaid