Healthcare Provider Details

I. General information

NPI: 1275180515
Provider Name (Legal Business Name): 1161 CAMBRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 W 2ND ST
RIVIERA BEACH FL
33404-7627
US

IV. Provider business mailing address

4285 NW 66TH PL
BOCA RATON FL
33496-4029
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-8089
  • Fax:
Mailing address:
  • Phone: 561-990-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA MARINOFF
Title or Position: MANAGER/OWNER
Credential:
Phone: 561-990-8089