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General NPI Number Information
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NPI Number | 1124423470
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Entity Type | Organization
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Legal Business Name | GREEN LIFE ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 840 SW 8TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8214
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Country | US
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Telephone | 855-331-6615
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Fax | 855-638-4902
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Provider Business Mailing Address
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Address Line | 840 SW 8TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8214
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Country | US
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Telephone | 855-331-6615
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Fax | 855-638-4902
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Authorized Official
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Title or Position | CEO
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Name | MS. MARI CLARK
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Credential |
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Telephone | 813-931-1433
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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 | AL12577
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License Number State | FL
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