Provider Demographics
NPI:1710265590
Name:DEERFIELD ASSISTED LIVING
Entity Type:Organization
Organization Name:DEERFIELD ASSISTED LIVING
Other - Org Name:WILLOW BAY AT DEERFIELD BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-818-6400
Mailing Address - Street 1:4001 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9408
Mailing Address - Country:US
Mailing Address - Phone:954-426-9700
Mailing Address - Fax:954-428-4337
Practice Address - Street 1:4001 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9408
Practice Address - Country:US
Practice Address - Phone:954-426-9700
Practice Address - Fax:954-428-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4777310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility