NPIMap

Organization Active NPI

Vida Nueva #1 Corp.

  • Assisted Living Facility
  • Miami, FL
National Provider Identifier
1972817534
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
10840 Issued in FL
Legal business name
VIDA NUEVA #1 CORP.
Practice address
745 N.W. 102 St.
Miami, FL 33150
Phone
(305) 758-1629
Fax
(305) 758-1958
NPI assigned
Aug 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Jean Gonzalez
Title
Administrator
Phone
(786) 312-4259

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 10840 FL Primary

Addresses

Primary practice location

745 N.W. 102 St.
Miami, FL 33150

Mailing address

745 N.W. 102 St.
Miami, FL 33150
Phone (305) 758-1629

Other identifiers 1

IdentifierTypeStateIssuer
001988309MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Vida Nueva 12 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1972817534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 N.W. 102 ST.",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33150",
            "telephone_number": "305-758-1629",
            "fax_number": "305-758-1958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 N.W. 102 ST.",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33150",
            "telephone_number": "305-758-1629",
            "fax_number": "305-758-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA NUEVA #1 CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "786-312-4259"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "10840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001988309",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.