Provider Demographics
NPI:1821434895
Name:SENIOR LIVING PROPERTIES-PENINSULA, LLC
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES-PENINSULA, LLC
Other - Org Name:THE PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:URI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-691-1030
Mailing Address - Street 1:4611 JOHNSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4361
Mailing Address - Country:US
Mailing Address - Phone:954-691-1030
Mailing Address - Fax:954-691-1036
Practice Address - Street 1:5100 W HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-7005
Practice Address - Country:US
Practice Address - Phone:954-893-7755
Practice Address - Fax:854-893-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9196310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility