Provider Demographics
NPI:1508808056
Name:ORANGE BLOSSOM RETIREMENT INC
Entity Type:Organization
Organization Name:ORANGE BLOSSOM RETIREMENT INC
Other - Org Name:ORANGE BLOSSOM MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-2121
Mailing Address - Street 1:3535 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5420
Mailing Address - Country:US
Mailing Address - Phone:954-961-8111
Mailing Address - Fax:
Practice Address - Street 1:3737 W ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-4029
Practice Address - Country:US
Practice Address - Phone:847-679-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL51203104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness