=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598934937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMANI OF PALM BEACH,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2008
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3217 BROADWAY
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-844-5313
-----------------------------------------------------
Fax | 561-844-0427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3217 BROADWAY
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-844-5313
-----------------------------------------------------
Fax | 561-844-0427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSD
-----------------------------------------------------
Name | JOHN FREELAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-844-5313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9012
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------