Provider Profile
EBENEZER FAMILY HOME III LLC
Assisted Living Facility
FACILITY PROFILE
Street Address
- 18309 SW 114TH CT
MIAMI, FL 33157-4989
County: Miami-Dade - Phone: (305) 256-9902
Mailing Address
- 18309 SW 114TH CT
MIAMI, FL 33157-4989
County: Miami-Dade - Phone: (305) 256-9902
AHCA Reports
Inspection ReportsInspection Details
Consumer Guides
Assisted Living in FloridaLong-Term Care
Patient Safety
Health Care Advance Directives
Facility Information:
| Facility/Provider Type: | Assisted Living Facility | ||||||
| Administrator: | ERICH CAPESTANY | ||||||
| Financial Officer: | ERICH CAPESTANY | ||||||
| Owner/Licensee: | EBENEZER FAMILY HOME III LLC | ||||||
| Owner/Licensee Since: | 3/5/2019 | ||||||
| |||||||
| Profit Status: | For-Profit | ||||||
| Management Company: | Not Available | ||||||
| Manager Since: | Not Available | ||||||
| Licensed Beds: | 6 | ||||||
| Bed Types: | Optional State Supplement: 6 Extended Congregate Care: 0 Private: 0 Total Capacity: 6 | ||||||
| AHCA Number (File Number): | 11967543 | ||||||
| AHCA Field Office: | 11 | ||||||
| License Number: | 11622 | ||||||
| Current License Effective: | 6/3/2023 | ||||||
| Current License Expires: | 6/2/2025 | ||||||
| License Status: | IN REVIEW | ||||||
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Specialty License: | Limited Mental Health |
| Activities: | Arts and CraftsDancingExercise ClassesGames/CardsSocial Events/Outings |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | EnglishSpanish |
| Nurse Availability: | None |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidOtherVA |
| Community Residential Home | Yes |
Please be advised that local zoning authorities may have additional restrictions or requirements not under the jurisdiction of the Agency for Health Care Administration. Contact your local zoning authorities for any specific requirements. See also 419.001 F.S.
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Portable Generator |
| Emergency Power Supports: | Air ConditioningLife Safety SystemsLightsRefrigeration |
| Plan Approval: | 9/3/2018 |
| Implementation Date: | 6/1/2018 |
| Cooling Method: | Air ConditionerFans |
| Areas Cooled: | Common AreasDining RoomLiving room |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 250 |
| Number of People to use Cooled Space: | 8 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| Change of ownership occurred 3/4/2019 | |||||
| 1/21/2015 | 2015000665 | Fine | Survey | $500.00 | 3/25/2015 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.