Provider Demographics
NPI:1194014431
Name:JFT OF THE PALM BEACHES
Entity Type:Organization
Organization Name:JFT OF THE PALM BEACHES
Other - Org Name:RUSTIC RETREAT ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-737-5887
Mailing Address - Street 1:1120 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3229
Mailing Address - Country:US
Mailing Address - Phone:561-737-5887
Mailing Address - Fax:561-734-4254
Practice Address - Street 1:1120 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3229
Practice Address - Country:US
Practice Address - Phone:561-737-5887
Practice Address - Fax:561-734-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5852310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility