Healthcare Provider Details

I. General information

NPI: 1902243405
Provider Name (Legal Business Name): PALM SHADES ADULT HOME CARE ,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 LINCOLN CIR E
LAKE WORTH FL
33463-6757
US

IV. Provider business mailing address

5702 LINCOLN CIR E
LAKE WORTH FL
33463-6757
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-8696
  • Fax: 561-964-8606
Mailing address:
  • Phone: 561-964-8606
  • Fax: 561-964-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAI11843
License Number StateFL

VIII. Authorized Official

Name: MRS. PAULINE ARAYA
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-667-3711