NPI: 1568880565
Provider Name: 2065 INC DBA FORT LAUDERDALE RETIREMENT HOME
Doing Business As: FORT LAUDERDALE RETIREMENT HOME
Classification: Assisted Living Facility - 3104A0625X
Entity Type: Organization
Specialization: Assisted Living, Mental Illness
CLIA Number: 10D2030289
Address:
401 SE 12TH CT
FORT LAUDERDALE, FL
ZIP 33316
Phone: (954) 270-6322
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2065 INC DBA FORT LAUDERDALE RETIREMENT HOME is an assisted living and mental illness assisted living facility in Fort Lauderdale, FL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. 2065 INC DBA FORT LAUDERDALE RETIREMENT HOME NPI is 1568880565. The provider is registered as an organization entity type.
The provider Is Doing Business As Fort Lauderdale Retirement Home.
The provider's business location address is:
401 SE 12TH CT
FORT LAUDERDALE, FL
ZIP 33316-919
Phone: (954) 270-6322
Fax: (954) 423-1674
The provider's authorized official is Jackie Henry Heath .
The authorized official title is Administrator/owner and has the following contact phone number (954) 270-6322.
The CLIA number assigned to this NPI record is 10D2030289 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 4/7/2014 and was last updated on 4/7/2014.