Country Club Living , Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10449 Issued in FL

Legal business name

COUNTRY CLUB LIVING , INC.

Doing business as

Miami Lakes Retirement Home

Practice address

16837 N. W. 91 CT.
Miami Lakes, FL 33018

Phone

(305) 549-8657

Fax

(305) 816-9996

NPI assigned

Apr 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yeney Suarez I

Title

Owner

Phone

(786) 715-8902

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MIAMI LAKES RETIREMENT HOME Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1063535854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16837 N. W. 91 CT.",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "33018",
            "telephone_number": "305-549-8657",
            "fax_number": "305-816-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16837 N. W. 91 CT.",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "33018",
            "telephone_number": "305-549-8657",
            "fax_number": "305-816-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB LIVING , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "SUAREZ",
        "authorized_official_first_name": "YENEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-715-8902",
        "authorized_official_name_suffix": "I"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL10449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142170100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "689009100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIAMI LAKES RETIREMENT HOME",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MIAMI LAKES RETIREMENT HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Costco Wholesale Corporation (Costco Pharmacy # 181)
• Costco Wholesale Corporation (Costco Hearing Aid #181)
• Costco Wholesale Corporation (Costco Optical #181)
• Zulia Coto Hernandez
• Yusley Couceiro, APRN
• Milexis De Los Angeles Couset Walker
• Arielle Couso
• Covitest
• Taylor James Cozad, DMD
• CR & Ra Investments LLC (Integrity Health Services)

• Assisted Living Facility in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.