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General NPI Number Information
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NPI Number | 1770983462
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Entity Type | Organization
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Legal Business Name | AFFECTIONATE CARE FOR LIFE
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 2313 Z TER
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-1803
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Country | US
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Telephone | 561-863-9517
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 Z TERRANCE
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City | WEST PALM
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-863-9517
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Fax | 561-444-3059
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARGARET ELIZBETH DAVIS
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Credential |
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Telephone | 561-863-9517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906680
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License Number State | FL
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