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General NPI Number Information
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NPI Number | 1861836017
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Entity Type | Organization
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Legal Business Name | ST. MARY'S ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 7001 S DIXIE HWY
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4803
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Country | US
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Telephone | 561-588-7677
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Fax | 561-588-1736
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Provider Business Mailing Address
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Address Line | 7001 S DIXIE HWY
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-4803
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Country | US
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Telephone | 561-588-7677
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Fax | 561-588-1736
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Authorized Official
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Title or Position | OWNER
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Name | MARY BURNISE HUBBS
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Credential |
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Telephone | 561-417-8870
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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 | AL9264
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License Number State | FL
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