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General NPI Number Information
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NPI Number | 1952719486
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Entity Type | Organization
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Legal Business Name | BCJ RETIREMENT HOME #2 INC
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 5760 NW 40TH TER
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4055
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Country | US
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Telephone | 954-970-7211
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Fax | 754-212-2772
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Provider Business Mailing Address
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Address Line | 5760 NW 40TH TER
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4055
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Country | US
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Telephone | 954-970-7211
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Fax | 754-212-2772
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BARBARA B WILSON
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Credential |
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Telephone | 954-254-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | AL12535
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License Number State | FL
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