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General NPI Number Information
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NPI Number | 1629311501
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Entity Type | Organization
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Legal Business Name | THE PALMS OF FLORIDA AFCH, LLC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 2460 S COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4117
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Country | US
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Telephone | 321-215-1641
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 S COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4117
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Country | US
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Telephone | 321-735-0814
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS JEANNETTE L PROPHETE
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Credential | LPN
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Telephone | 321-735-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 6906335
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License Number State | FL
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