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General NPI Number Information
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NPI Number | 1669176756
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Entity Type | Organization
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Legal Business Name | 621 PLANTATION ALF LLC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 621 NW 76TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-1440
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Country | US
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Telephone | 845-596-2743
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 HOLLYWOOD BLVD STE 605
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JORDAN SCHILLER
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Credential |
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Telephone | 845-596-2743
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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 |
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License Number State |
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