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General NPI Number Information
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NPI Number | 1013858190
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Entity Type | Organization
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Legal Business Name | COLONIAL GARDENS RESIDENCES LLC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 2801 NW 55TH AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-2509
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Country | US
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Telephone | 954-484-1960
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Fax | 954-766-1657
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Provider Business Mailing Address
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Address Line | 2801 NW 55TH AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-2509
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Country | US
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Telephone | 954-484-1960
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Fax | 954-766-1657
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Authorized Official
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Title or Position | OWNER
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Name | MIRVIAN RODRIGUEZ
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Credential |
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Telephone | 954-484-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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