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General NPI Number Information
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NPI Number | 1851173413
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Entity Type | Organization
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Legal Business Name | CROWN ASSISTED LIVING
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 132 NW 9TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-2669
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Country | US
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Telephone | 561-674-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 8736 ESCONDIDO WAY E
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City | BOCA RATON
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State | FL
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Zip | 33433-2511
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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 | OWNER
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Name | MR. YVENET JESUCA
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Credential | NP
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Telephone | 561-674-4554
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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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