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General NPI Number Information
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NPI Number | 1245587146
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Entity Type | Organization
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Legal Business Name | ADULT QUALITY CARE HOMES, INC.
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 14327 69TH DR N
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City | WEST PALM BEACH
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State | FL
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Zip | 33418-7240
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Country | US
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Telephone | 561-622-1348
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Fax | 561-828-2366
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Provider Business Mailing Address
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Address Line | 4869 NW 124TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3464
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Country | US
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Telephone | 954-415-1106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CLYDE WESLEY LARMAN
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Credential |
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Telephone | 561-622-1348
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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 | 5699
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License Number State | FL
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