MEDICARE: HIBISCUS BY-THE-SEA OF SOUTH FLORIDA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL6618	FL

General Provider Information

NPI Number	:	1063615086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBISCUS BY-THE-SEA OF SOUTH FLORIDA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 540369
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33454-0369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7357 WILSON RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-2240
Country	:	US
Telephone Number	:	561-683-7877
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH A LUPO
Credential	:
Telephone Number	:	561-502-2200

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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