Provider Demographics
NPI:1902243405
Name:PALM SHADES ADULT HOME CARE ,INC
Entity Type:Organization
Organization Name:PALM SHADES ADULT HOME CARE ,INC
Other - Org Name:PALM SHADES ADULT HOME CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-667-3711
Mailing Address - Street 1:5702 LINCOLN CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6757
Mailing Address - Country:US
Mailing Address - Phone:561-964-8606
Mailing Address - Fax:561-964-8606
Practice Address - Street 1:5702 LINCOLN CIR E
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6757
Practice Address - Country:US
Practice Address - Phone:561-964-8696
Practice Address - Fax:561-964-8606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINORA BLAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAI11843261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care