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General NPI Number Information
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NPI Number | 1528464260
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Entity Type | Organization
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Legal Business Name | FOREVER YOUNG OF THE PALM BEACHES ADULT DAY CARE, LLC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 4650 PORTOFINO WAY APT 212 BLDG 22
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-8159
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Country | US
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Telephone | 561-255-3029
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Fax | 561-640-8277
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Provider Business Mailing Address
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Address Line | 4650 PORTOFINO WAY APT 212 BLDG 22
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-8159
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Country | US
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Telephone | 561-255-3029
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Fax | 561-640-8277
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Authorized Official
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Title or Position | CEO/DIRECT OWNER
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Name | MRS. SHONDA JORDAN WALKER
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Credential | RN
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Telephone | 561-255-3029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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