Provider Demographics
NPI:1275911000
Name:THE PALM BEACH HOME FOR ADULTS
Entity Type:Organization
Organization Name:THE PALM BEACH HOME FOR ADULTS
Other - Org Name:THE WATERFORD ON THE BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCLAFANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-891-8400
Mailing Address - Street 1:2900 BRAGG STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-891-8400
Mailing Address - Fax:718-568-3383
Practice Address - Street 1:2900 BRAGG STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-891-8400
Practice Address - Fax:718-568-3383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PALM BEACH HOME FOR ADULTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility