Provider Demographics
NPI:1548765019
Name:ORANGE BLOSSOMS VILLA IV
Entity Type:Organization
Organization Name:ORANGE BLOSSOMS VILLA IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-762-1492
Mailing Address - Street 1:121 MARTIN CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1708
Mailing Address - Country:US
Mailing Address - Phone:561-762-1492
Mailing Address - Fax:561-282-6892
Practice Address - Street 1:121 MARTIN CIR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1708
Practice Address - Country:US
Practice Address - Phone:561-762-1492
Practice Address - Fax:561-282-6892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE BLOSSOMS VILLA III
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12552310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility