Green Street Alf, Corp

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12805 Issued in FL

Legal business name

GREEN STREET ALF, CORP

Practice address

12262 SW 250TH Ter
Homestead, FL 33032-5952

Phone

(786) 274-0144

Fax

(855) 299-0714

NPI assigned

Mar 18, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Carlos E Caballero

Title

Owner/Administrator

Phone

(786) 274-0144

Specialties & licenses 1

Addresses

Other names 1

• GREEN STREET ALF, CORP Former legal business name

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1831550847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12262 SW 250TH TER",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330325952",
            "telephone_number": "786-274-0144",
            "fax_number": "855-299-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12262 SW 250TH TER",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330325952",
            "telephone_number": "786-274-0144",
            "fax_number": "855-299-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN STREET ALF, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "CABALLERO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "786-274-0144",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREEN STREET ALF, CORP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Assisted Living Facility in Homestead, FL
• Providers in Homestead, 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 Mar 18, 2016; 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.