Provider Demographics
NPI:1003188491
Name:ATLANTIC SHORE RETIREMENT RESIDENCE
Entity Type:Organization
Organization Name:ATLANTIC SHORE RETIREMENT RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMBRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-941-7974
Mailing Address - Street 1:1500 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3310
Mailing Address - Country:US
Mailing Address - Phone:954-941-7974
Mailing Address - Fax:954-942-2896
Practice Address - Street 1:1500 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3310
Practice Address - Country:US
Practice Address - Phone:954-941-7974
Practice Address - Fax:954-942-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL0005954310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility