Provider Demographics
NPI:1649476870
Name:LAUDERDALE LAKES ALZHEIMER CARE CENTER
Entity type:Organization
Organization Name:LAUDERDALE LAKES ALZHEIMER CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TREASA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-535-2801
Mailing Address - Street 1:4320 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5506
Mailing Address - Country:US
Mailing Address - Phone:954-535-2800
Mailing Address - Fax:954-777-3249
Practice Address - Street 1:4320 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5506
Practice Address - Country:US
Practice Address - Phone:954-535-2800
Practice Address - Fax:954-777-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6807259-00Medicaid