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General NPI Number Information
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NPI Number | 1831481019
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Entity Type | Organization
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Legal Business Name | A NEW AGE OF SENIOR CARE AT WELLINGTON
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 1074 HYACINTH PL UNIT D
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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 | 561-847-4548
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Fax | 800-391-6830
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Provider Business Mailing Address
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Address Line | 1074 HYACINTH PL UNIT D
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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 | 561-847-4548
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Fax | 800-391-6830
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANTONIO LUIS BORGES
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Credential |
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Telephone | 561-847-4548
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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 | AL11924
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License Number State | FL
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