Provider Demographics
NPI:1730575705
Name:DAHLIA'S HOUSE OF LOVE LLC
Entity type:Organization
Organization Name:DAHLIA'S HOUSE OF LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:917-674-2052
Mailing Address - Street 1:3081 ELDRON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6306
Mailing Address - Country:US
Mailing Address - Phone:321-327-4104
Mailing Address - Fax:321-802-4015
Practice Address - Street 1:143 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-1110
Practice Address - Country:US
Practice Address - Phone:321-952-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12619310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility