MEDICARE: APOLLO GARDENS RETIREMENT RESIDENCE CARE

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	7341	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	:	1134325418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO GARDENS RETIREMENT RESIDENCE CARE

Provider Business Mailing Address
First Line	:	2718 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3824
Country	:	US
Telephone Number	:	954-923-5553
Fax Number	:	954-920-5358

Provider Business Practice Location Address
First Line	:	2718 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3824
Country	:	US
Telephone Number	:	954-923-5553
Fax Number	:	954-920-5358

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GRACE UEBERLAUER
Credential	:
Telephone Number	:	954-923-1354

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	08/22/2020

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