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General NPI Number Information
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NPI Number | 1851948418
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Entity Type | Organization
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Legal Business Name | 3411 AVE CAMBRIDGE LLC
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 3411 AVENUE H E
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-2101
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Country | US
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Telephone | 561-990-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 4285 NW 66TH PL
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City | BOCA RATON
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State | FL
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Zip | 33496-4029
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Country | US
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Telephone | 561-990-8089
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | CLAUDIA A MARINOFF
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Credential |
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Telephone | 561-990-8089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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