Provider Demographics
NPI:1427212463
Name:RETIREMENT LIFE CENTER
Entity Type:Organization
Organization Name:RETIREMENT LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:G
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-733-1840
Mailing Address - Street 1:5640 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2391
Mailing Address - Country:US
Mailing Address - Phone:954-733-1840
Mailing Address - Fax:
Practice Address - Street 1:5640 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2391
Practice Address - Country:US
Practice Address - Phone:954-733-1840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6674310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility