Provider Demographics
NPI:1225371875
Name:OCTAVIA GARDENS ASSISTED LIVING FACILITY INC
Entity Type:Organization
Organization Name:OCTAVIA GARDENS ASSISTED LIVING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-305-3229
Mailing Address - Street 1:315 LAS PALMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1029
Mailing Address - Country:US
Mailing Address - Phone:561-753-2293
Mailing Address - Fax:
Practice Address - Street 1:315 LAS PALMAS ST
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1029
Practice Address - Country:US
Practice Address - Phone:561-753-2293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCTAVIA GARDENS ASSISTED LIVING FACILITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11711310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility