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General NPI Number Information
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NPI Number | 1386353886
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Entity Type | Organization
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Legal Business Name | RUSTIC RETREAT FLORIDA LLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 1120 N FEDERAL HWY
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-3229
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Country | US
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Telephone | 561-737-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 3711 LONG BEACH BLVD STE 900
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City | LONG BEACH
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State | CA
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Zip | 90807-3315
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Country | US
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Telephone | 562-517-0055
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SAMUEL SUFRIN
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Credential |
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Telephone | 562-517-0055
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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 |
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License Number State |
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