Provider Demographics
NPI:1831481019
Name:A NEW AGE OF SENIOR CARE AT WELLINGTON
Entity Type:Organization
Organization Name:A NEW AGE OF SENIOR CARE AT WELLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-847-4548
Mailing Address - Street 1:1074 HYACINTH PL
Mailing Address - Street 2:UNIT D
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2144
Mailing Address - Country:US
Mailing Address - Phone:561-847-4548
Mailing Address - Fax:800-391-6830
Practice Address - Street 1:1074 HYACINTH PL
Practice Address - Street 2:UNIT D
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2144
Practice Address - Country:US
Practice Address - Phone:561-847-4548
Practice Address - Fax:800-391-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11924310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11924OtherAHCA LICENSE NUMBER