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General NPI Number Information
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NPI Number | 1538531447
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Entity Type | Organization
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Legal Business Name | ST JOSEPH RESIDENCE INC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 3485 NW 30TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1890
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Country | US
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Telephone | 954-739-1483
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Fax | 954-485-3952
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Provider Business Mailing Address
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Address Line | 3485 NW 30TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1890
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Country | US
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Telephone | 954-739-1483
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Fax | 954-485-3952
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMIE BONAVITA-RHODES
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Credential |
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Telephone | 954-739-1483
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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 | AL7380
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License Number State | FL
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