Provider Demographics
NPI:1841457413
Name:GARDENS RETREAT, INC.
Entity type:Organization
Organization Name:GARDENS RETREAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-287-9713
Mailing Address - Street 1:4405 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-5368
Mailing Address - Country:US
Mailing Address - Phone:772-287-9713
Mailing Address - Fax:772-287-9713
Practice Address - Street 1:4405 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-5368
Practice Address - Country:US
Practice Address - Phone:772-287-9713
Practice Address - Fax:772-287-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11039310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility