Provider Demographics
NPI:1003059460
Name:INTERGRATED LIVING COMMUNITIES OF WPB, LLC
Entity Type:Organization
Organization Name:INTERGRATED LIVING COMMUNITIES OF WPB, LLC
Other - Org Name:HERONS RUN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WINSOME
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-963-8963
Mailing Address - Street 1:2939 S HAVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8118
Mailing Address - Country:US
Mailing Address - Phone:561-963-8963
Mailing Address - Fax:561-963-8966
Practice Address - Street 1:2939 S HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-8118
Practice Address - Country:US
Practice Address - Phone:561-963-8963
Practice Address - Fax:561-963-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8091310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility