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CHRISTALLIS MANOR III NPI 1083228332


NPI Information

NPI: 1083228332
Provider Name: CHRISTALLIS MANOR III

Doing Business As: BEACHSIDE LIVING LLC

Classification: Assisted Living Facility - 3104A0630X
Entity Type: Organization

Specialization: Assisted Living, Behavioral Disturbances

CLIA Number: 10D2201041

Address:
420 N RIVERSIDE DR
POMPANO BEACH, FL
ZIP 33062
Phone: (954) 274-5573
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CHRISTALLIS MANOR III is an assisted living and behavioral disturbances assisted living facility in Pompano Beach, FL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. CHRISTALLIS MANOR III NPI is 1083228332. The provider is registered as an organization entity type.
The provider Is Doing Business As Beachside Living Llc.

The provider's business location address is:

420 N RIVERSIDE DR
POMPANO BEACH, FL
ZIP 33062-035
Phone: (954) 274-5573

The provider's authorized official is Amparo M Dierking .
The authorized official title is Administrator and has the following contact phone number (954) 274-5573.

The CLIA number assigned to this NPI record is 10D2201041 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2020 and was last updated on 3/18/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13104A0630XAssisted Living FacilityAssisted Living, Behavioral DisturbancesYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1107611700MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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