Provider Demographics
NPI:1184861098
Name:KAMANI OF THE PALM BEACH, INC.
Entity Type:Organization
Organization Name:KAMANI OF THE PALM BEACH, INC.
Other - Org Name:DOREEN'S ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-649-8535
Mailing Address - Street 1:6266 S CONGRESS AVE STE L5
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2308
Mailing Address - Country:US
Mailing Address - Phone:561-649-8535
Mailing Address - Fax:
Practice Address - Street 1:3217 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5136
Practice Address - Country:US
Practice Address - Phone:561-844-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL143078500Medicaid