Provider Demographics
NPI:1952719486
Name:BCJ RETIREMENT HOME #2 INC
Entity Type:Organization
Organization Name:BCJ RETIREMENT HOME #2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-254-0159
Mailing Address - Street 1:5760 NW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4055
Mailing Address - Country:US
Mailing Address - Phone:954-970-7211
Mailing Address - Fax:754-212-2772
Practice Address - Street 1:5760 NW 40TH TER
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4055
Practice Address - Country:US
Practice Address - Phone:954-970-7211
Practice Address - Fax:754-212-2772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCJ RETIREMENT HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL125353104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances