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General NPI Number Information
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NPI Number | 1740430909
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Entity Type | Organization
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Legal Business Name | FAIRWAY PARK RETIREMENT FACILITY, CORP.
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 16360 SW 92ND CT
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City | VILLAGE OF PALMETTO BAY
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State | FL
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Zip | 33157-3460
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Country | US
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Telephone | 786-286-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 16360 SW 92ND CT
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City | VILLAGE OF PALMETTO BAY
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State | FL
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Zip | 33157-3460
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Country | US
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Telephone | 786-286-4484
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIE REGNIER
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Credential |
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Telephone | 786-286-4484
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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 | 10692
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 8673
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License Number State | FL
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