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General NPI Number Information
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NPI Number | 1346585452
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Entity Type | Organization
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Legal Business Name | ORANGE BLOSSOMS VILLA III, LLC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 11030 56TH PL N
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-8811
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Country | US
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Telephone | 561-904-0808
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Fax | 561-282-6892
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Provider Business Mailing Address
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Address Line | 11030 56TH PL N
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-8811
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Country | US
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Telephone | 561-904-0808
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Fax | 561-282-6892
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. MARIA ANNA CUMMINGS
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Credential |
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Telephone | 561-762-1492
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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 | AL 12283
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License Number State | FL
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