Healthcare Provider Details

I. General information

NPI: 1013858190
Provider Name (Legal Business Name): COLONIAL GARDENS RESIDENCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 55TH AVE
LAUDERHILL FL
33313-2509
US

IV. Provider business mailing address

2801 NW 55TH AVE
LAUDERHILL FL
33313-2509
US

V. Phone/Fax

Practice location:
  • Phone: 954-484-1960
  • Fax: 954-766-1657
Mailing address:
  • Phone: 954-484-1960
  • Fax: 954-766-1657

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: MIRVIAN RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 954-484-1960