Provider Demographics
NPI:1346661618
Name:PALM GARDENS MANOR INC/DBAPALMGARDENS3
Entity Type:Organization
Organization Name:PALM GARDENS MANOR INC/DBAPALMGARDENS3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-970-8812
Mailing Address - Street 1:5835 W 14TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6250
Mailing Address - Country:US
Mailing Address - Phone:305-970-8812
Mailing Address - Fax:305-825-5007
Practice Address - Street 1:6245 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6411
Practice Address - Country:US
Practice Address - Phone:305-970-8812
Practice Address - Fax:305-825-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9800310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831510247Medicaid
FL1447412267Medicaid