Provider Demographics
NPI:1851541510
Name:PEACEFUL GARDENS, LLC
Entity Type:Organization
Organization Name:PEACEFUL GARDENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAZAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-210-7034
Mailing Address - Street 1:3941 NW 173RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3821
Mailing Address - Country:US
Mailing Address - Phone:786-210-7034
Mailing Address - Fax:
Practice Address - Street 1:3941 NW 173RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3821
Practice Address - Country:US
Practice Address - Phone:786-210-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11424310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility