Provider Demographics
NPI:1427594209
Name:GREEN PALMS HOME, LLC
Entity Type:Organization
Organization Name:GREEN PALMS HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELSAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-235-3255
Mailing Address - Street 1:17430 SW 118TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2270
Mailing Address - Country:US
Mailing Address - Phone:305-235-3255
Mailing Address - Fax:305-235-3255
Practice Address - Street 1:17430 SW 118TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2270
Practice Address - Country:US
Practice Address - Phone:305-235-3255
Practice Address - Fax:305-235-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8287310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility