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General NPI Number Information
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NPI Number | 1710314331
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Entity Type | Organization
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Legal Business Name | GENA'S RETIREMENT HOME
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 2233 NW 56 AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-452-4416
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 NW 56TH AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-3003
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Country | US
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Telephone | 954-733-9614
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Fax | 954-733-9614
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GENA ACKBERSINGH
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Credential |
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Telephone | 954-452-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 4973
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License Number State | FL
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