Provider Demographics
NPI:1730397969
Name:LILITA HOME 2 ALF
Entity type:Organization
Organization Name:LILITA HOME 2 ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-6293
Mailing Address - Street 1:4503 NW 203RD TER
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1243
Mailing Address - Country:US
Mailing Address - Phone:305-362-6293
Mailing Address - Fax:305-225-1289
Practice Address - Street 1:4503 NW 203RD TER
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-1243
Practice Address - Country:US
Practice Address - Phone:305-362-6293
Practice Address - Fax:305-225-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10419310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142183200Medicaid