Provider Demographics
NPI:1275086357
Name:FAIR BREEZE LLC
Entity Type:Organization
Organization Name:FAIR BREEZE LLC
Other - Org Name:FAIR BREEZE SENIOR HOMES AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WILLIAMS SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:954-680-7846
Mailing Address - Street 1:5146 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3625
Mailing Address - Country:US
Mailing Address - Phone:954-680-7846
Mailing Address - Fax:
Practice Address - Street 1:5146 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3625
Practice Address - Country:US
Practice Address - Phone:954-680-7846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311Z00000X, 311ZA0620X
FLW452501626361347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle