Healthcare Provider Details

I. General information

NPI: 1417556028
Provider Name (Legal Business Name): 5081 CAMBRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5081 NW DUNN RD
FORT PIERCE FL
34981-4942
US

IV. Provider business mailing address

4285 NW 66TH PL
BOCA RATON FL
33496-4029
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-8089
  • Fax: 561-584-7505
Mailing address:
  • Phone: 561-990-8089
  • Fax: 561-584-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAUDIA A MARINOFF
Title or Position: CFO
Credential:
Phone: 561-990-8089