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General NPI Number Information
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NPI Number | 1053520809
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Entity Type | Organization
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Legal Business Name | WILLOW HAVEN ALF, INC.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/24/2011
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Provider Practice Location Address
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Address Line | 1220 NE 207TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-2019
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Country | US
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Telephone | 305-653-3894
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 NE 207TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-2019
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Country | US
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Telephone | 305-653-3894
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BLANCA PEREZ
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Credential |
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Telephone | 305-653-3894
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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 | 10457
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License Number State | FL
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