MEDICARE: GRAND COURT 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	AL5464	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL5464	OTHER	FL	PROVIDER LICENSE NUMBER

General Provider Information

NPI Number	:	1760816730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND COURT ALF 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	:	954-942-3388
Fax Number	:	954-942-8901

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	:	954-942-3388
Fax Number	:	954-942-8901

Authorized Official
Title or Position	:	OPERATOR
Name	:	SANDRA BEER
Credential	:
Telephone Number	:	718-705-9304

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	08/27/2013

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