Healthcare Provider Details

I. General information

NPI: 1073032694
Provider Name (Legal Business Name): EMERALD PARK ALF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 STIRLING RD
HOLLYWOOD FL
33021-1549
US

IV. Provider business mailing address

5770 STIRLING RD
HOLLYWOOD FL
33021-1549
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9431
License Number StateFL

VIII. Authorized Official

Name: ZEVI KOHN
Title or Position: MEMBER
Credential:
Phone: 718-338-2999