MEDICARE: AMWIL ASSISTED LIVING

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	302R00000X	Health Maintenance Organization	AL9975	FL

General Provider Information

NPI Number	:	1497939417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMWIL ASSISTED LIVING

Provider Business Mailing Address
First Line	:	840 SW 8TH ST
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-8214
Country	:	US
Telephone Number	:	954-943-4606
Fax Number	:	954-943-5016

Provider Business Practice Location Address
First Line	:	840 SW 8TH ST
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-8214
Country	:	US
Telephone Number	:	954-943-4606
Fax Number	:	954-943-5016

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. ANTONIETTA BANCOLITA LLANES
Credential	:
Telephone Number	:	954-943-4606

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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Directions to “AMWIL ASSISTED LIVING ” Practice Location

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