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General NPI Number Information
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NPI Number | 1154896124
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Entity Type | Organization
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Legal Business Name | HOME SUITEHOME LLC
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 9286 BIRMINGHAM DR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5924
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Country | US
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Telephone | 561-318-6177
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Fax |
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Provider Business Mailing Address
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Address Line | 18629 LOCHPOINT CT
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City | JUPITER
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State | FL
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Zip | 33458-3866
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Country | US
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Telephone | 561-379-6433
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Fax | 561-828-3100
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | DAVE WHELIHAN
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Credential |
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Telephone | 561-379-6433
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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 |
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