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General NPI Number Information
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NPI Number | 1124452883
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Entity Type | Organization
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Legal Business Name | HOLY GARDEN ALF, INC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 2904 N 36TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-1391
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Country | US
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Telephone | 954-961-6005
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Fax | 954-362-9377
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Provider Business Mailing Address
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Address Line | 2904 N 36TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-1391
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Country | US
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Telephone | 954-961-6005
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Fax | 954-362-9377
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIA LUPULESCU
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Credential |
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Telephone | 965-961-6005
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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 | 12110
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License Number State | FL
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