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General NPI Number Information
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NPI Number | 1124461710
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Entity Type | Organization
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Legal Business Name | ST PAULS PLACE
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 5400 PLUNKETT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8025
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Country | US
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Telephone | 786-427-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 5312 PLUNKETT ST STE A
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8024
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Country | US
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Telephone | 786-427-5258
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Fax |
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Authorized Official
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Title or Position | VP
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Name | MS. EBONY PACE CRAWFORD
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Credential |
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Telephone | 954-962-2622
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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 |
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License Number State | FL
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