Healthcare Provider Details

I. General information

NPI: 1649476870
Provider Name (Legal Business Name): LAUDERDALE LAKES ALZHEIMER CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 NW 36TH ST
LAUDERDALE LAKES FL
33319-5506
US

IV. Provider business mailing address

4320 NW 36TH ST
LAUDERDALE LAKES FL
33319-5506
US

V. Phone/Fax

Practice location:
  • Phone: 954-535-2800
  • Fax: 954-777-3249
Mailing address:
  • Phone: 954-535-2800
  • Fax: 954-777-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. TREASA BROWN
Title or Position: DIRECTOR
Credential:
Phone: 954-535-2801