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General NPI Number Information
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NPI Number | 1275086357
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Entity Type | Organization
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Legal Business Name | FAIR BREEZE LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 5146 SW 90TH AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-3625
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Country | US
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Telephone | 954-680-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 5146 SW 90TH AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-3625
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Country | US
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Telephone | 954-680-7846
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. KARIE ANNETTE WILLIAMS SOTO
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Credential | CSA
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Telephone | 954-680-7846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | W452501626361
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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