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General NPI Number Information
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NPI Number | 1093157182
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Entity Type | Organization
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Legal Business Name | ORCHID GARDEN ALF
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 403 SW 74TH AVE
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-1432
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Country | US
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Telephone | 954-720-1317
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Fax |
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Provider Business Mailing Address
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Address Line | 403 SW 74TH AVE
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-1432
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Country | US
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Telephone | 954-720-1317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CASSILDA EVANS
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Credential |
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Telephone | 954-629-4581
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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 | AL10683
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License Number State | FL
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