Provider Demographics
NPI:1306227293
Name:BLACK FAMILY HERITAGE ESTATES MINISTRY
Entity Type:Organization
Organization Name:BLACK FAMILY HERITAGE ESTATES MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-625-4772
Mailing Address - Street 1:3465 NW 43RD PL
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4240
Mailing Address - Country:US
Mailing Address - Phone:954-625-4772
Mailing Address - Fax:
Practice Address - Street 1:3465 NW 43RD PL
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4240
Practice Address - Country:US
Practice Address - Phone:954-625-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child