MEDICARE: JENKINS HARMONY HOME

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	AL6096	FL

General Provider Information

NPI Number	:	1528408838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENKINS HARMONY HOME

Provider Business Mailing Address
First Line	:	2640 NW 16TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-4419
Country	:	US
Telephone Number	:	954-458-0891
Fax Number	:	954-484-7564

Provider Business Practice Location Address
First Line	:	2640 NW 16TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-4419
Country	:	US
Telephone Number	:	954-458-0891
Fax Number	:	954-484-7564

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ALBERTHA JENKINS
Credential	:
Telephone Number	:	954-485-0891

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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