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General NPI Number Information
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NPI Number | 1104260637
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Entity Type | Organization
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Legal Business Name | SOUTH OAKS ASSISTED LIVING HOME LLC
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 6141 SW 34TH ST
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City | MIRAMAR
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State | FL
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Zip | 33023-5129
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Country | US
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Telephone | 954-983-7996
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Fax | 954-391-9627
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Provider Business Mailing Address
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Address Line | 6141 SW 34TH ST
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City | MIRAMAR
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State | FL
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Zip | 33023-5129
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Country | US
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Telephone | 954-983-7996
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Fax | 954-391-9627
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Authorized Official
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Title or Position | OWNER
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Name | MR. BERNARD EVERTON THOMAS
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Credential |
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Telephone | 954-983-7996
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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 | AL5855
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License Number State | FL
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