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General NPI Number Information
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NPI Number | 1760015556
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Entity Type | Organization
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Legal Business Name | RENLIV MANOR ALF LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 17930 62ND RD N
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-3217
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Country | US
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Telephone | 561-509-4054
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Fax |
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Provider Business Mailing Address
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Address Line | 17930 62ND RD N
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-3217
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Country | US
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Telephone | 561-509-4054
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. YOLENE EUGENE
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Credential | RN
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Telephone | 561-509-4054
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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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