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General NPI Number Information
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NPI Number | 1730575705
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Entity Type | Organization
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Legal Business Name | DAHLIA'S HOUSE OF LOVE LLC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 143 DEER RUN RD
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City | PALM BAY
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State | FL
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Zip | 32909-1110
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Country | US
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Telephone | 321-952-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 3081 ELDRON BLVD SE
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City | PALM BAY
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State | FL
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Zip | 32909-6306
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Country | US
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Telephone | 321-327-4104
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Fax | 321-802-4015
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. DAHLIA COLE
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Credential | RN
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Telephone | 917-674-2052
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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 | AL12619
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License Number State | FL
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