Provider Demographics
NPI:1720413206
Name:BUCKINGHAM PLACE LLC
Entity Type:Organization
Organization Name:BUCKINGHAM PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:V
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOKOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-921-1819
Mailing Address - Street 1:1845 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3115
Mailing Address - Country:US
Mailing Address - Phone:954-921-1819
Mailing Address - Fax:
Practice Address - Street 1:1845 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3115
Practice Address - Country:US
Practice Address - Phone:954-921-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10172310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility