| Organization Name: | MI CASA ADULT LIVING FACILITY HOME, INC |
| NPI Number: | 1205070539 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESUS R CASTILLO (OWNER) |
| Mailing Address: | 6856 Saint Augustine Rd Jacksonville |
| State: | FL US |
| Postal Code: | 322172818 |
| Phone Number: | 9047393927 |
| Fax Number: | 9044480130 |
| NPI Enumeration Date: | 04/30/2009 |
| NPI Last Update Date: | 07/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 11548 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |