Provider Demographics
NPI:1730246927
Name:SANTA CLARA ALF, INC.
Entity type:Organization
Organization Name:SANTA CLARA ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-216-2638
Mailing Address - Street 1:6120 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:786-513-5928
Practice Address - Street 1:2830 SW 106TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2748
Practice Address - Country:US
Practice Address - Phone:305-221-9955
Practice Address - Fax:786-513-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9834310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142293600Medicaid