Provider Demographics
NPI:1538864681
Name:CRUZ FAMILY HOME LLC
Entity type:Organization
Organization Name:CRUZ FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:YOANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-406-9359
Mailing Address - Street 1:3037 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1909
Mailing Address - Country:US
Mailing Address - Phone:786-536-9797
Mailing Address - Fax:305-381-1636
Practice Address - Street 1:3037 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1909
Practice Address - Country:US
Practice Address - Phone:786-536-9797
Practice Address - Fax:305-381-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13782OtherAHCA