MEDICARE: ORANGE BLOSSOMS VILLA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL10957	FL

General Provider Information

NPI Number	:	1598260945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE BLOSSOMS VILLA LLC

Provider Business Mailing Address
First Line	:	151 MEADOWLARK DR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-2966
Country	:	US
Telephone Number	:	561-762-1492
Fax Number	:	561-282-6892

Provider Business Practice Location Address
First Line	:	151 MEADOWLARK DR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-2966
Country	:	US
Telephone Number	:	561-762-1492
Fax Number	:	561-282-6892

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARIA ANNA CUMMINGS
Credential	:
Telephone Number	:	561-762-1492

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

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