Provider Demographics
NPI:1144817768
Name:NENA'S ON THE LAKE, ALF
Entity type:Organization
Organization Name:NENA'S ON THE LAKE, ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-554-6278
Mailing Address - Street 1:8140 NW 47TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5630
Mailing Address - Country:US
Mailing Address - Phone:954-554-6278
Mailing Address - Fax:954-697-0999
Practice Address - Street 1:8140 NW 47TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5630
Practice Address - Country:US
Practice Address - Phone:954-554-6278
Practice Address - Fax:954-697-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106161300Medicaid