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General NPI Number Information
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NPI Number | 1083719751
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Entity Type | Organization
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Legal Business Name | COVENANT LIVING OF FLORIDA, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 9215 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2404
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Country | US
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Telephone | 954-472-2860
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Fax | 954-472-5934
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Provider Business Mailing Address
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Address Line | 9211 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2401
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Country | US
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Telephone | 954-472-2860
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Fax | 954-472-5934
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Authorized Official
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Title or Position | VICE PRESIDENT OF HEALTH SERVICES
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Name | ELIZABETH MALZAHN
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Credential |
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Telephone | 773-878-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF11080961
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License Number State | FL
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