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General NPI Number Information
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NPI Number | 1932543782
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Entity Type | Organization
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Legal Business Name | CORAL SPRINGS COUNTRY CLUB FOR SENIORS, INC.
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 2903 NW 115TH TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3439
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Country | US
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Telephone | 954-839-4791
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 NW 115TH TER
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3439
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Country | US
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Telephone | 954-839-4791
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PETRINEA A MATTIS
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Credential | MBA/HCM
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Telephone | 954-839-4791
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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 | AL10582
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License Number State | FL
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