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General NPI Number Information
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NPI Number | 1356572192
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Entity Type | Organization
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Legal Business Name | JBS ASSISTED LIVING HOME INC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 1511 NW 10TH AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-5410
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Country | US
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Telephone | 954-990-4847
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Fax |
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Provider Business Mailing Address
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Address Line | 1517 NW 10TH AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-5410
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Country | US
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Telephone | 954-369-8282
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Fax |
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Authorized Official
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Title or Position | ADMINASTRATOR
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Name | DENICE BRYANT
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Credential |
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Telephone | 954-369-8282
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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 | AL11448
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License Number State | FL
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