Healthcare Provider Details

I. General information

NPI: 1487940391
Provider Name (Legal Business Name): PEACE ON EARTH II ALF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SW 14TH COURT
POMPANO BEACH FL
33060
US

IV. Provider business mailing address

470 SW 14TH COURT
POMPANO BEACH FL
33060
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-3454
  • Fax: 954-227-4657
Mailing address:
  • Phone: 954-544-3454
  • Fax: 954-227-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number11315
License Number StateFL

VIII. Authorized Official

Name: CHRISTINE ROBERTS
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 954-227-2358