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General NPI Number Information
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NPI Number | 1770806002
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Entity Type | Organization
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Legal Business Name | PALM HAVEN ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 1646 W RIVER DR
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City | MARGATE
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State | FL
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Zip | 33063-2729
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Country | US
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Telephone | 954-471-6303
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 W RIVER DR
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City | MARGATE
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State | FL
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Zip | 33063-2729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZEB GARDNER
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Credential |
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Telephone | 954-471-6303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | PTA012528
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License Number State | FL
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