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General NPI Number Information
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NPI Number | 1285990762
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Entity Type | Organization
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Legal Business Name | ROSE OF SHARON GARDEN ALF
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 8400 NW 28 ST.
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City | SUNRISE
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State | FL
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Zip | 33322
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Country | US
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Telephone | 954-747-0869
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Fax | 954-749-9644
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Provider Business Mailing Address
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Address Line | 8400 NW 28TH ST
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City | SUNRISE
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State | FL
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Zip | 33322-2314
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Country | US
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Telephone | 954-747-0869
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Fax | 954-749-9644
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARLINE ROBERTS JACKSON
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Credential | CNA, MA.
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Telephone | 954-821-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | AL10291
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License Number State | FL
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