Provider Demographics
NPI:1710307079
Name:CAYMAN CIRCLE ADULT FAMILY CARE
Entity Type:Organization
Organization Name:CAYMAN CIRCLE ADULT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-512-8149
Mailing Address - Street 1:5843 CAYMAN CIR W
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1853
Mailing Address - Country:US
Mailing Address - Phone:561-512-8149
Mailing Address - Fax:
Practice Address - Street 1:5843 CAYMAN CIR W
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1853
Practice Address - Country:US
Practice Address - Phone:561-512-8149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12609310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011712300Medicaid
FL12609OtherSTATE LICENSE