Healthcare Provider Details

I. General information

NPI: 1225024268
Provider Name (Legal Business Name): LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S FLAGLER DR
WEST PALM BEACH FL
33401-5613
US

IV. Provider business mailing address

315 S FLAGLER DR
WEST PALM BEACH FL
33401-5613
US

V. Phone/Fax

Practice location:
  • Phone: 561-655-8544
  • Fax: 561-650-8952
Mailing address:
  • Phone: 561-655-8544
  • Fax: 561-650-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1298095
License Number StateFL

VIII. Authorized Official

Name: MARY ANNE DENNEHY
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 561-655-8544