Provider Demographics
NPI:1477720340
Name:HIDDEN GARDEN ASSISTED LIVING RESIDENCE LLC
Entity Type:Organization
Organization Name:HIDDEN GARDEN ASSISTED LIVING RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:561-471-1766
Mailing Address - Street 1:4373 VENUS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4041
Mailing Address - Country:US
Mailing Address - Phone:561-471-1766
Mailing Address - Fax:561-471-1905
Practice Address - Street 1:4373 VENUS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4041
Practice Address - Country:US
Practice Address - Phone:561-471-1766
Practice Address - Fax:561-471-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10597310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility