Provider Demographics
NPI:1861678393
Name:CEREBRAL PALSY ADULT HOME, INC.
Entity Type:Organization
Organization Name:CEREBRAL PALSY ADULT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-786-0344
Mailing Address - Street 1:1001 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-5712
Mailing Address - Country:US
Mailing Address - Phone:965-786-0344
Mailing Address - Fax:954-785-6635
Practice Address - Street 1:1405 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-2342
Practice Address - Country:US
Practice Address - Phone:954-786-0344
Practice Address - Fax:954-785-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-1454GH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities