MEDICARE: ASSISTED LIVING OF PALM BEACH GARDENS

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	AL11205	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073789186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING OF PALM BEACH GARDENS

Provider Business Mailing Address
First Line	:	9239 W HIGHLAND PINES DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-5756
Country	:	US
Telephone Number	:	561-691-8630
Fax Number	:	561-691-8631

Provider Business Practice Location Address
First Line	:	9239 W HIGHLAND PINES DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-5756
Country	:	US
Telephone Number	:	561-691-8630
Fax Number	:	561-691-8631

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TINA SANDERS
Credential	:
Telephone Number	:	561-718-2201

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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Directions to “ASSISTED LIVING OF PALM BEACH GARDENS ” Practice Location

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