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General NPI Number Information
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NPI Number | 1184962003
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Entity Type | Organization
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Legal Business Name | PALM LAKE VILLAGE HOUSING CORPORATION
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 3800 62ND AVE N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-6055
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Country | US
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Telephone | 727-489-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 62ND AVE N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-6055
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Country | US
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Telephone | 727-489-6440
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LISA ELLIOTT
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Credential |
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Telephone | 727-489-6440
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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 | AL10314
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License Number State | FL
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