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General NPI Number Information
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NPI Number | 1154639243
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Entity Type | Organization
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Legal Business Name | ANNMARIE CAMPBELL ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 320 PENNSYLVANIA AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-1835
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Country | US
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Telephone | 954-554-2916
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Fax |
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Provider Business Mailing Address
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Address Line | 320 PENNSYLVANIA AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-1835
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Country | US
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Telephone | 954-554-2916
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. ANNMARIE CAMPBELL
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Credential |
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Telephone | 954-554-2916
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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 | 6906326
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License Number State | FL
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