Provider Demographics
NPI:1386813764
Name:WYNDHAM HOUSE
Entity Type:Organization
Organization Name:WYNDHAM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-832-6545
Mailing Address - Street 1:417 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7933
Mailing Address - Country:US
Mailing Address - Phone:561-832-6545
Mailing Address - Fax:561-832-6507
Practice Address - Street 1:417 WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7933
Practice Address - Country:US
Practice Address - Phone:561-832-6545
Practice Address - Fax:561-832-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL63310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility