Provider Demographics
NPI:1013214725
Name:CHRISTIE'S PLACE ASSISTED LIVING FAC
Entity Type:Organization
Organization Name:CHRISTIE'S PLACE ASSISTED LIVING FAC
Other - Org Name:CHRISTIE PLACE ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-549-5231
Mailing Address - Street 1:471 ALMANSA ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3183
Mailing Address - Country:US
Mailing Address - Phone:321-727-0905
Mailing Address - Fax:321-727-0905
Practice Address - Street 1:471 ALMANSA ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3183
Practice Address - Country:US
Practice Address - Phone:321-727-0905
Practice Address - Fax:321-727-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIES.PLACE@YAHOO.COM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-15
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11757310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility