Healthcare Provider Details

I. General information

NPI: 1144749771
Provider Name (Legal Business Name): PLAZA OF PEMBROKE 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

3535 SW 52ND AVE
PEMBROKE PARK FL
33023-5420
US

IV. Provider business mailing address

3535 SW 52ND AVE
PEMBROKE PARK FL
33023-5420
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5120
License Number StateFL

VIII. Authorized Official

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