Provider Demographics
NPI:1003817636
Name:THE PLACE AT WEST PALM BEACH INC
Entity Type:Organization
Organization Name:THE PLACE AT WEST PALM BEACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:561-686-5100
Mailing Address - Street 1:2090 N CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8210
Mailing Address - Country:US
Mailing Address - Phone:561-686-5100
Mailing Address - Fax:561-686-9530
Practice Address - Street 1:2090 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8210
Practice Address - Country:US
Practice Address - Phone:561-686-5100
Practice Address - Fax:561-686-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8367310400000X
FLSNF16290951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-5875Medicare ID - Type Unspecified