Provider Demographics
NPI:1598044265
Name:SEASIDE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SEASIDE HEALTHCARE, LLC
Other - Org Name:SEASIDE RETIREMENT RESORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-457-0100
Mailing Address - Street 1:2091 S OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6645
Mailing Address - Country:US
Mailing Address - Phone:954-457-0100
Mailing Address - Fax:954-455-4514
Practice Address - Street 1:2091 S OCEAN DR
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6645
Practice Address - Country:US
Practice Address - Phone:954-457-0100
Practice Address - Fax:954-455-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7722310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility