Provider Demographics
NPI:1336581131
Name:COCONUT CREEK ALF INC
Entity Type:Organization
Organization Name:COCONUT CREEK ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-427-2161
Mailing Address - Street 1:3420 NW 71ST ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4801
Mailing Address - Country:US
Mailing Address - Phone:954-427-2161
Mailing Address - Fax:954-427-2161
Practice Address - Street 1:3420 NW 71ST ST
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4801
Practice Address - Country:US
Practice Address - Phone:954-427-2161
Practice Address - Fax:954-427-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11167310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility