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General NPI Number Information
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NPI Number | 1497453088
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Entity Type | Organization
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Legal Business Name | SILVER SPARKS RESIDENTIAL CARE LLC DBA ADULT LEISURE LIVING
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 15650 W BUNCHE PARK DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33054-6965
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Country | US
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Telephone | 305-705-2347
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Fax |
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Provider Business Mailing Address
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Address Line | 15650 W BUNCHE PARK DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33054-6965
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Country | US
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Telephone | 305-705-2347
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAVERN MARIE GORDON THOMAS
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Credential |
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Telephone | 786-506-6778
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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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