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General NPI Number Information
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NPI Number | 1669632857
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Entity Type | Organization
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Legal Business Name | AVALON PARK RETIREMENT RESIDENCE
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 600 N 62ND AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7857
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Country | US
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Telephone | 954-981-4822
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Fax | 954-963-9561
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Provider Business Mailing Address
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Address Line | 600 N 62ND AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7857
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Country | US
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Telephone | 954-981-4822
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Fax | 954-963-9561
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Authorized Official
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Title or Position | VP
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Name | MRS. MAGGIE KULNICK
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Credential |
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Telephone | 954-981-4822
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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 | AL6653
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License Number State | FL
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