Provider Demographics
NPI:1225609977
Name:ST MARY'S ASSITED LIVING RESIDENCE LLC
Entity Type:Organization
Organization Name:ST MARY'S ASSITED LIVING RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-990-8089
Mailing Address - Street 1:4285 NW 66TH PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4029
Mailing Address - Country:US
Mailing Address - Phone:561-990-8089
Mailing Address - Fax:561-584-7505
Practice Address - Street 1:7001 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4803
Practice Address - Country:US
Practice Address - Phone:561-588-7677
Practice Address - Fax:561-584-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-04
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility