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General NPI Number Information
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NPI Number | 1558633875
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Entity Type | Organization
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Legal Business Name | SUNHAVEN VILLA ALF
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 11810 NW 30TH PL
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City | SUNRISE
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State | FL
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Zip | 33323-1520
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Country | US
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Telephone | 954-746-3982
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Fax | 954-533-3234
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Provider Business Mailing Address
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Address Line | 11810 NW 30TH PL
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City | SUNRISE
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State | FL
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Zip | 33323-1520
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Country | US
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Telephone | 954-746-3982
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Fax | 954-533-3234
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DENISE SEALE-BROWN
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Credential |
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Telephone | 954-746-3982
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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 | 11474
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License Number State | FL
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