Provider Demographics
NPI:1679941777
Name:THE PERFECT PLACE ALF 3
Entity Type:Organization
Organization Name:THE PERFECT PLACE ALF 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VEJERANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-307-6994
Mailing Address - Street 1:1517 SW BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1517 SW BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1102
Practice Address - Country:US
Practice Address - Phone:786-307-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12722310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility