Provider Demographics
NPI:1144749771
Name:PLAZA OF PEMBROKE ALF LLC
Entity Type:Organization
Organization Name:PLAZA OF PEMBROKE ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-338-2999
Mailing Address - Street 1:3535 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 SW 52ND AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5420
Practice Address - Country:US
Practice Address - Phone:954-961-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5120OtherALF