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General NPI Number Information
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NPI Number | 1457808230
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Entity Type | Organization
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Legal Business Name | PATH OF LIFE ASSISTED LIVING
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 1240 SUMMERWOOD CIR
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City | WELLINGTON
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State | FL
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Zip | 33414-5147
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Country | US
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Telephone | 561-798-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 GUN CLUB RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-2508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JESSICA HERNANDEZ
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Credential |
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Telephone | 305-282-2620
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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 | AL12696
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License Number State | FL
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