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General NPI Number Information
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NPI Number | 1154712495
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Entity Type | Organization
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Legal Business Name | A BELLA VITA PLACE ASSISTED LIVING,LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 2143 DORSON WAY
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2438
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Country | US
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Telephone | 561-201-4534
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Fax | 561-908-2649
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Provider Business Mailing Address
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Address Line | 2143 DORSON WAY
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2438
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Country | US
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Telephone | 561-201-4534
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Fax | 561-908-2649
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MRS. NICOLE BEAUZIEUX-GERMAIN
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Credential |
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Telephone | 561-201-4534
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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 | AL12591
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License Number State | FL
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