Provider Demographics
NPI:1548694482
Name:THE TRUSTTEES OF ADVENT LUTHERAN CHURCH, INC./ADVENT SQU
Entity type:Organization
Organization Name:THE TRUSTTEES OF ADVENT LUTHERAN CHURCH, INC./ADVENT SQU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-948-1738
Mailing Address - Street 1:4798 N. DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5055
Mailing Address - Country:US
Mailing Address - Phone:561-391-7207
Mailing Address - Fax:561-544-1560
Practice Address - Street 1:4798 N. DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5055
Practice Address - Country:US
Practice Address - Phone:561-391-7207
Practice Address - Fax:561-544-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11947310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105852000Medicaid