Healthcare Provider Details

I. General information

NPI: 1780870154
Provider Name (Legal Business Name): PALM BEACH NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 54TH ST
WEST PALM BEACH FL
33407-2419
US

IV. Provider business mailing address

1101 54TH ST
WEST PALM BEACH FL
33407-2419
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-8401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM P MANDO
Title or Position: CFO
Credential:
Phone: 813-635-9500