Provider Demographics
NPI:1376951087
Name:VERONA GARDENS AT CORAL RIDGE LLC
Entity Type:Organization
Organization Name:VERONA GARDENS AT CORAL RIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:POL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-288-0656
Mailing Address - Street 1:7771 W OAKLAND PARK BLVD
Mailing Address - Street 2:STE 152
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6749
Mailing Address - Country:US
Mailing Address - Phone:954-288-0656
Mailing Address - Fax:954-343-5835
Practice Address - Street 1:2625 NE 13TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1505
Practice Address - Country:US
Practice Address - Phone:954-288-0656
Practice Address - Fax:954-343-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12531310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility