Provider Demographics
NPI:1932511755
Name:NOVA PALMS ALF INC
Entity Type:Organization
Organization Name:NOVA PALMS ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MALA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-789-6517
Mailing Address - Street 1:1600 TAFT ST
Mailing Address - Street 2:ALF UNIT
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3272
Mailing Address - Country:US
Mailing Address - Phone:954-362-3487
Mailing Address - Fax:954-362-3489
Practice Address - Street 1:1600 TAFT ST
Practice Address - Street 2:ALF UNIT
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3272
Practice Address - Country:US
Practice Address - Phone:954-362-3487
Practice Address - Fax:954-362-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12023310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003479800Medicaid