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General NPI Number Information
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NPI Number | 1548694482
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Entity Type | Organization
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Legal Business Name | THE TRUSTTEES OF ADVENT LUTHERAN CHURCH, INC./ADVENT SQU
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 4798 N. DIXIE HWY
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City | BOCA RATON
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State | FL
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Zip | 33431-5055
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Country | US
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Telephone | 561-391-7207
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Fax | 561-544-1560
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Provider Business Mailing Address
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Address Line | 4798 N. DIXIE HWY
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City | BOCA RATON
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State | FL
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Zip | 33431-5055
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Country | US
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Telephone | 561-391-7207
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Fax | 561-544-1560
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CECILIA E CARROLL
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Credential |
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Telephone | 561-948-1738
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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 | AL11947
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License Number State | FL
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