Provider Demographics
NPI:1558633875
Name:SUNHAVEN VILLA ALF
Entity Type:Organization
Organization Name:SUNHAVEN VILLA ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALE-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-746-3982
Mailing Address - Street 1:11810 NW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1520
Mailing Address - Country:US
Mailing Address - Phone:954-746-3982
Mailing Address - Fax:954-533-3234
Practice Address - Street 1:11810 NW 30TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1520
Practice Address - Country:US
Practice Address - Phone:954-746-3982
Practice Address - Fax:954-533-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11474310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility