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General NPI Number Information
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NPI Number | 1285066134
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Entity Type | Organization
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Legal Business Name | LEISURE LAND ALF INC
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 2301 NE 12TH TER
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5518
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Country | US
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Telephone | 754-300-8895
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 NE 12TH TER
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5518
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Country | US
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Telephone | 754-300-8895
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISRATOR
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Name | ERICA ROBINSON
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Credential |
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Telephone | 850-702-4984
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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 | 12330
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License Number State | FL
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