Provider Demographics
NPI:1568801553
Name:HIDDEN PINES ALF
Entity Type:Organization
Organization Name:HIDDEN PINES ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-312-4701
Mailing Address - Street 1:16242 SYCAMORE DR E
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3704
Mailing Address - Country:US
Mailing Address - Phone:561-383-8838
Mailing Address - Fax:561-753-4812
Practice Address - Street 1:16242 SYCAMORE DR E
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3704
Practice Address - Country:US
Practice Address - Phone:561-383-8838
Practice Address - Fax:561-753-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10390310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility