Provider Demographics
NPI:1225024268
Name:LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE
Entity Type:Organization
Organization Name:LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DENNEHY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:561-655-8544
Mailing Address - Street 1:315 S FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5613
Mailing Address - Country:US
Mailing Address - Phone:561-655-8544
Mailing Address - Fax:561-650-8952
Practice Address - Street 1:315 S FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5613
Practice Address - Country:US
Practice Address - Phone:561-655-8544
Practice Address - Fax:561-650-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1298095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105420Medicare ID - Type UnspecifiedMEDICARE PROVIDER