Provider Demographics
NPI:1477884104
Name:PEMBROOK PLACE ALF INC.
Entity Type:Organization
Organization Name:PEMBROOK PLACE ALF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTRELLA
Authorized Official - Middle Name:LABIOS
Authorized Official - Last Name:MONTECLARO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-536-5865
Mailing Address - Street 1:2331 PEMBROOK DR.
Mailing Address - Street 2:PEMBROOK PLACE ALF INC.
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764
Mailing Address - Country:US
Mailing Address - Phone:727-536-5865
Mailing Address - Fax:727-539-1484
Practice Address - Street 1:2331 PEMBROOK DR.
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764
Practice Address - Country:US
Practice Address - Phone:727-536-5865
Practice Address - Fax:727-539-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALF LEVEL 2 #AL7581310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility