MEDICARE: THE LORD'S PLACE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1427369024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LORD'S PLACE

Provider Business Mailing Address
First Line	:	2808 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4592
Country	:	US
Telephone Number	:	561-494-0125
Fax Number	:	561-494-2922

Provider Business Practice Location Address
First Line	:	2808 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4592
Country	:	US
Telephone Number	:	561-494-0125
Fax Number	:	561-494-2922

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DIANA STANLEY
Credential	:
Telephone Number	:	561-494-0125

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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Directions to “THE LORD'S PLACE ” Practice Location

Language	Start Address	Practice Location

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