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General NPI Number Information
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NPI Number | 1417440561
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Entity Type | Organization
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Legal Business Name | ROYAL PALM RESIDENCE INC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 1961 SW 70TH AVE
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City | PLANTATION
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State | FL
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Zip | 33317-5032
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Country | US
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Telephone | 954-920-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 S OCEAN DR APT 302S
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City | HOLLYWOOD
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State | FL
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Zip | 33019-2716
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Country | US
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Telephone | 954-920-0990
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Fax | 954-920-0660
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SCOT A BENNETT
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Credential |
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Telephone | 954-920-0990
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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 | AL13112
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License Number State | FL
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