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General NPI Number Information
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NPI Number | 1770132755
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Entity Type | Organization
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Legal Business Name | HIBISCUS PALACE WELLINGTON LLC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1074 HYACINTH PL APT C
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City | WELLINGTON
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State | FL
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Zip | 33414-2144
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Country | US
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Telephone | 561-333-4179
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Fax | 561-909-1548
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Provider Business Mailing Address
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Address Line | 7181 VIA LEONARDO
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City | LAKE WORTH
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State | FL
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Zip | 33467-5236
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Country | US
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Telephone | 561-385-2532
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Fax | 561-909-1548
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANDREA WRIGHT MATTIS
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Credential | MSN, RN
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Telephone | 561-385-2532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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