MEDICARE: GARDENS AT MAPLEWOOD

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	AL9451	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780026526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENS AT MAPLEWOOD

Provider Business Mailing Address
First Line	:	1342 NW 104TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-3900
Country	:	US
Telephone Number	:	954-263-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1342 NW 104TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-3900
Country	:	US
Telephone Number	:	954-263-4070
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW T JOHNSTON
Credential	:
Telephone Number	:	954-263-4070

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “GARDENS AT MAPLEWOOD ” Practice Location

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