Provider Demographics
NPI:1255699468
Name:PALM COTTAGE OPERATOR, LLC
Entity type:Organization
Organization Name:PALM COTTAGE OPERATOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-704-4722
Mailing Address - Street 1:3821 SUNNYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5100
Mailing Address - Country:US
Mailing Address - Phone:321-633-1819
Mailing Address - Fax:321-639-7328
Practice Address - Street 1:3821 SUNNYSIDE CT
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5100
Practice Address - Country:US
Practice Address - Phone:321-633-1819
Practice Address - Fax:321-639-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9987310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility