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General NPI Number Information
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NPI Number | 1487940391
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Entity Type | Organization
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Legal Business Name | PEACE ON EARTH II ALF, INC.
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 470 SW 14TH COURT
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City | POMPANO BEACH
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State | FL
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Zip | 33060
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Country | US
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Telephone | 954-544-3454
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Fax | 954-227-4657
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Provider Business Mailing Address
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Address Line | 470 SW 14TH COURT
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City | POMPANO BEACH
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State | FL
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Zip | 33060
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Country | US
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Telephone | 954-544-3454
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Fax | 954-227-4657
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | CHRISTINE ROBERTS
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Credential |
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Telephone | 954-227-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 11315
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License Number State | FL
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