MEDICARE: RESIDENCE AT POMPANO BEACH LLC

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

General Provider Information

NPI Number	:	1558139394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENCE AT POMPANO BEACH LLC

Provider Business Mailing Address
First Line	:	295 SW 4TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 SW 4TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6933
Country	:	US
Telephone Number	:	954-942-6000
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MORDECHAI WEISZ
Credential	:
Telephone Number	:	347-631-4068

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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