Provider Demographics
NPI:1174763007
Name:SPECIAL LIFE MOMENTS,INC
Entity type:Organization
Organization Name:SPECIAL LIFE MOMENTS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-295-4064
Mailing Address - Street 1:8902 NW 177TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6689
Mailing Address - Country:US
Mailing Address - Phone:786-295-4064
Mailing Address - Fax:305-512-7060
Practice Address - Street 1:8902 NW 177TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6689
Practice Address - Country:US
Practice Address - Phone:786-295-4064
Practice Address - Fax:305-512-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11417310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility