Healthcare Provider Details

I. General information

NPI: 1821434895
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES-PENINSULA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W HALLANDALE BEACH BLVD
HOLLYWOOD FL
33023-7005
US

IV. Provider business mailing address

4611 JOHNSON RD SUITE 1
COCONUT CREEK FL
33073-4361
US

V. Phone/Fax

Practice location:
  • Phone: 954-893-7755
  • Fax: 854-893-6733
Mailing address:
  • Phone: 954-691-1030
  • Fax: 954-691-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9196
License Number StateFL

VIII. Authorized Official

Name: URI RUBIN
Title or Position: CFO
Credential:
Phone: 954-691-1030