Provider Demographics
NPI:1447412267
Name:PALM GARDENS MANORS INC
Entity Type:Organization
Organization Name:PALM GARDENS MANORS INC
Other - Org Name:A NEW HORIZON MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-821-9865
Mailing Address - Street 1:1232 W 60ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-821-9865
Mailing Address - Fax:305-825-5007
Practice Address - Street 1:1232 W 60ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-821-9865
Practice Address - Fax:305-825-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALF7757310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004764300Medicaid
FL678592100Medicaid
FL140704000Medicaid
FL141873400Medicaid
FL142206500Medicaid
FL686738300Medicaid
FL678612000Medicaid