Provider Demographics
NPI:1275876138
Name:AVERY COTTAGE INC
Entity Type:Organization
Organization Name:AVERY COTTAGE INC
Other - Org Name:NOBLE COVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NETTECHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-434-6999
Mailing Address - Street 1:4052 COLLIN DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4813
Mailing Address - Country:US
Mailing Address - Phone:561-434-6999
Mailing Address - Fax:
Practice Address - Street 1:4052 COLLIN DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4813
Practice Address - Country:US
Practice Address - Phone:561-434-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERY COTTAGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10887310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility