Provider Demographics
NPI:1518733153
Name:PRESTIGE CARE HALLANDALE LLC
Entity type:Organization
Organization Name:PRESTIGE CARE HALLANDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-397-3829
Mailing Address - Street 1:19840 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2208
Mailing Address - Country:US
Mailing Address - Phone:305-397-3829
Mailing Address - Fax:305-912-7799
Practice Address - Street 1:105 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6337
Practice Address - Country:US
Practice Address - Phone:305-397-3829
Practice Address - Fax:305-912-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility