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NPI Code Detail

MEDICARE: LAS PALMAS SENIOR LIVING LLC

MEDICARE: LAS PALMAS SENIOR LIVING 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1598472003
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAS PALMAS SENIOR LIVING LLC
Provider Business Mailing Address
First Line : 1105 E COUNTY LINE RD STE 201
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-2122
Country : US
Telephone Number : 973-285-2893
Fax Number :
Provider Business Practice Location Address
First Line : 5300 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-2104
Country : US
Telephone Number : 305-290-3801
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF AR
Name : BLIMI AVIV
Credential :
Telephone Number : 973-285-2893
Provider Enumeration Date : 11/03/2022
Last Update Date : 11/03/2022

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Directions to “LAS PALMAS SENIOR LIVING LLC ” Practice Location

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