Provider Demographics
NPI:1295032415
Name:PALM SPRINGS NORTH ALF, INC.
Entity Type:Organization
Organization Name:PALM SPRINGS NORTH ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:VILLALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-7721
Mailing Address - Street 1:8511 NW 185TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2550
Mailing Address - Country:US
Mailing Address - Phone:305-300-7721
Mailing Address - Fax:305-819-3762
Practice Address - Street 1:8511 NW 185TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2550
Practice Address - Country:US
Practice Address - Phone:305-300-7721
Practice Address - Fax:305-819-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9760310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000210600Medicaid