Provider Demographics
NPI:1205387636
Name:WELLINESS LIVING IN PLANTATION
Entity Type:Organization
Organization Name:WELLINESS LIVING IN PLANTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-287-1041
Mailing Address - Street 1:221 NW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2050
Mailing Address - Country:US
Mailing Address - Phone:786-287-1041
Mailing Address - Fax:786-287-1041
Practice Address - Street 1:221 NW 49TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2050
Practice Address - Country:US
Practice Address - Phone:786-287-1041
Practice Address - Fax:786-287-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility