Provider Demographics
NPI:1003252149
Name:MELODY PLACE
Entity Type:Organization
Organization Name:MELODY PLACE
Other - Org Name:A DBA OF EMERALD GARDEN, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUHANI
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN/BS
Authorized Official - Phone:727-723-1332
Mailing Address - Street 1:35 HARBOR WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5347
Mailing Address - Country:US
Mailing Address - Phone:727-797-9402
Mailing Address - Fax:
Practice Address - Street 1:1815 EAGLE TRACE BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3314
Practice Address - Country:US
Practice Address - Phone:727-723-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7599310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility