Provider Demographics
NPI:1376887372
Name:ORANGE BLOSSOMS VILLA LLC
Entity Type:Organization
Organization Name:ORANGE BLOSSOMS VILLA LLC
Other - Org Name:MEADOWLARK INN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-762-1492
Mailing Address - Street 1:10331 PIPPIN LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3018
Mailing Address - Country:US
Mailing Address - Phone:561-762-1492
Mailing Address - Fax:561-282-6892
Practice Address - Street 1:10331 PIPPIN LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3018
Practice Address - Country:US
Practice Address - Phone:561-762-1492
Practice Address - Fax:561-282-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10383310400000X
FLAL 10957310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility