MEDICARE: DELMA HICKS ALF

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	:	1942477310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELMA HICKS ALF

Provider Business Mailing Address
First Line	:	4245 NW 73RD WAY
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2156
Country	:	US
Telephone Number	:	954-850-1854
Fax Number	:	954-796-3380

Provider Business Practice Location Address
First Line	:	4245 NW 73RD WAY
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2156
Country	:	US
Telephone Number	:	954-850-1854
Fax Number	:	954-796-3380

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	DELMA C HICKS
Credential	:	ADMINISTRATOR ALF
Telephone Number	:	954-850-1854

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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