MEDICARE: PHILLIPS HAVEN ALF 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	:	1740137785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPS HAVEN ALF LLC

Provider Business Mailing Address
First Line	:	1824 PRIMROSE LN
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8673
Country	:	US
Telephone Number	:	561-312-4587
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 PRIMROSE LN
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8673
Country	:	US
Telephone Number	:	561-312-4587
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. JANICE PHILLIPS
Credential	:
Telephone Number	:	561-312-4587

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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