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General NPI Number Information
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NPI Number | 1093058075
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Entity Type | Organization
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Legal Business Name | EMMANUEL CARE ASSISTED LIVING FACILITY, INC.
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 3628 DAISY AVE
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4713
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Country | US
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Telephone | 561-627-3674
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Fax | 561-799-5196
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Provider Business Mailing Address
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Address Line | 3628 DAISY AVE
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4713
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Country | US
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Telephone | 561-627-3674
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Fax | 561-799-5196
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LEITHA A SANDERS
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Credential | LPN
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Telephone | 561-627-3674
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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 | AL11412
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License Number State | FL
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