Provider Demographics
NPI:1679947733
Name:SHIRLEY HOUSE ALF,INC
Entity type:Organization
Organization Name:SHIRLEY HOUSE ALF,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-891-3095
Mailing Address - Street 1:1422 SHIRLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6015
Mailing Address - Country:US
Mailing Address - Phone:561-410-5672
Mailing Address - Fax:561-410-5778
Practice Address - Street 1:1422 SHIRLEY CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6015
Practice Address - Country:US
Practice Address - Phone:561-410-5672
Practice Address - Fax:561-410-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12762310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility