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General NPI Number Information
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NPI Number | 1861678393
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Entity Type | Organization
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Legal Business Name | CEREBRAL PALSY ADULT HOME, INC.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 1405 NW 10TH ST
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City | DANIA
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State | FL
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Zip | 33004-2342
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Country | US
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Telephone | 954-786-0344
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Fax | 954-785-6635
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Provider Business Mailing Address
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Address Line | 1001 NE 3RD AVE
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City | POMPANO BEACH
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State | FL
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Zip | 33060-5712
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Country | US
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Telephone | 965-786-0344
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Fax | 954-785-6635
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARSHA FAYE LINVILLE
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Credential |
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Telephone | 954-786-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 10-1454GH
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License Number State | FL
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