Provider Demographics
NPI:1790123578
Name:OCTAVIA GARDENS ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:OCTAVIA GARDENS ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-305-3229
Mailing Address - Street 1:5652 S RUE RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7148
Mailing Address - Country:US
Mailing Address - Phone:561-305-3229
Mailing Address - Fax:
Practice Address - Street 1:5652 S RUE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7148
Practice Address - Country:US
Practice Address - Phone:561-305-3229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCTAVIA GARDENS ASSISTED LIVING FACILITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12183310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility