Provider Demographics
NPI:1629311501
Name:THE PALMS OF FLORIDA AFCH, LLC
Entity Type:Organization
Organization Name:THE PALMS OF FLORIDA AFCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROPHETE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:321-735-0814
Mailing Address - Street 1:2460 S COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4117
Mailing Address - Country:US
Mailing Address - Phone:321-735-0814
Mailing Address - Fax:
Practice Address - Street 1:2460 S COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4117
Practice Address - Country:US
Practice Address - Phone:321-215-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PALMS OF FLORIDA AFCH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906335376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty