Provider Demographics
NPI:1306384326
Name:HIBISCUS PALACE II ASSISTED LIVING FACILITY LLC.
Entity Type:Organization
Organization Name:HIBISCUS PALACE II ASSISTED LIVING FACILITY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-385-2532
Mailing Address - Street 1:7181 VIA LEONARDO
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5236
Mailing Address - Country:US
Mailing Address - Phone:561-385-2532
Mailing Address - Fax:561-909-1548
Practice Address - Street 1:12842 BUCKLAND ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6223
Practice Address - Country:US
Practice Address - Phone:561-557-3513
Practice Address - Fax:561-909-1548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIBISCUS PALACE ASSISTED LIVING FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12943310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility