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General NPI Number Information
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NPI Number | 1831711399
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Entity Type | Organization
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Legal Business Name | PALMETTO BAY RETIREMENT HOME
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 9220 SW 174TH STREET
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City | PALMETTO BAY
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State | FL
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Zip | 33157
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Country | US
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Telephone | 305-281-6839
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Fax | 786-497-3407
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Provider Business Mailing Address
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Address Line | 170 OCEAN LANE DRIVE #405
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City | KEY BISCAYNE
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State | FL
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Zip | 33149
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Country | US
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Telephone | 305-281-6839
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Fax | 786-497-3407
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | PAMELA QUIROGA
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Credential |
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Telephone | 305-281-6839
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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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