Provider Demographics
NPI:1326251224
Name:TERRACE COMMUNITIES TEQUESTA, LLC
Entity Type:Organization
Organization Name:TERRACE COMMUNITIES TEQUESTA, LLC
Other - Org Name:TEQUESTA TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-207-6500
Mailing Address - Street 1:400 NORTH U.S. ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469
Mailing Address - Country:US
Mailing Address - Phone:561-207-6500
Mailing Address - Fax:561-207-6549
Practice Address - Street 1:400 NORTH U.S. ROUTE ONE
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469
Practice Address - Country:US
Practice Address - Phone:561-207-6500
Practice Address - Fax:561-207-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10124310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility