Provider Demographics
NPI:1437389921
Name:PALM SPRINGS NORTH MANOR INC
Entity Type:Organization
Organization Name:PALM SPRINGS NORTH MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENY
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-970-8941
Mailing Address - Street 1:7861 NW 175 ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3633
Mailing Address - Country:US
Mailing Address - Phone:305-970-8941
Mailing Address - Fax:305-826-3823
Practice Address - Street 1:7861 NW 175 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3633
Practice Address - Country:US
Practice Address - Phone:305-970-8941
Practice Address - Fax:305-826-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11384261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care