Provider Demographics
NPI:1285837559
Name:CENTRAL PALACE SERVICES, INC.
Entity Type:Organization
Organization Name:CENTRAL PALACE SERVICES, INC.
Other - Org Name:CENTRAL PALACE RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMENIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-445-3565
Mailing Address - Street 1:4491 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2563
Mailing Address - Country:US
Mailing Address - Phone:305-445-3565
Mailing Address - Fax:
Practice Address - Street 1:4491 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2563
Practice Address - Country:US
Practice Address - Phone:305-445-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7107310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142407600Medicaid