MEDICARE: PERSONAL ELDER CARE II

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	10658	FL

General Provider Information

NPI Number	:	1942508676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL ELDER CARE II

Provider Business Mailing Address
First Line	:	5739 ORCHARD WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5704
Country	:	US
Telephone Number	:	561-687-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 ORCHARD WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5704
Country	:	US
Telephone Number	:	561-687-8845
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. NADIA TAIJWATIE DOOKHI
Credential	:
Telephone Number	:	561-707-9855

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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