=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164688651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNT & COUNTESS DE HOERNLE ALZHEIMER'S PAVILION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 NW 2ND AVE
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33441-1971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-420-0704
-----------------------------------------------------
Fax | 954-419-9943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 NW 2ND AVE
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33441-1971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-420-0704
-----------------------------------------------------
Fax | 954-419-9943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. ALICIA SCHINDLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-420-0704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL8415
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------