Provider Demographics
NPI:1508020710
Name:PROFESSIONAL RETIREMENT HOME, INC
Entity Type:Organization
Organization Name:PROFESSIONAL RETIREMENT HOME, INC
Other - Org Name:LEHIGH ASSISTED LIVING FACILITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:954-587-2198
Mailing Address - Street 1:1900 SW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5416
Mailing Address - Country:US
Mailing Address - Phone:954-587-2198
Mailing Address - Fax:954-533-3621
Practice Address - Street 1:1900 SW 51ST TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5416
Practice Address - Country:US
Practice Address - Phone:954-587-2198
Practice Address - Fax:954-533-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health