Provider Demographics
NPI:1841324050
Name:CORAL PLAZA RETIREMENT RESIDENCE, LLC
Entity type:Organization
Organization Name:CORAL PLAZA RETIREMENT RESIDENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-949-2626
Mailing Address - Street 1:15520 NORTH WEST SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:954-949-2626
Mailing Address - Fax:305-940-3945
Practice Address - Street 1:5850 MARGATE BLVD.
Practice Address - Street 2:CORAL PLAZA RETIREMENT RESIDENCE, LLC
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-970-0053
Practice Address - Fax:954-971-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7861310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility