Provider Demographics
NPI:1184680506
Name:PALMS OF LAUDERDALE LAKES
Entity Type:Organization
Organization Name:PALMS OF LAUDERDALE LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-358-1660
Mailing Address - Street 1:7491 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4989
Mailing Address - Country:US
Mailing Address - Phone:954-358-1660
Mailing Address - Fax:
Practice Address - Street 1:3370 NW 47TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-6701
Practice Address - Country:US
Practice Address - Phone:954-733-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1098096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030800500Medicaid
FL030800500Medicaid