Healthcare Provider Details

I. General information

NPI: 1891038030
Provider Name (Legal Business Name): TOWERS RETIREMENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 SE 2ND ST
FORT LAUDERDALE FL
33301-3606
US

IV. Provider business mailing address

824 SE 2ND ST
FORT LAUDERDALE FL
33301-3606
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-4973
  • Fax: 954-463-7025
Mailing address:
  • Phone: 954-463-4973
  • Fax: 954-463-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL6654
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL6654
License Number StateFL

VIII. Authorized Official

Name: MARK A NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-463-4973