1841324050 NPI number — CORAL PLAZA RETIREMENT RESIDENCE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841324050 NPI number — CORAL PLAZA RETIREMENT RESIDENCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAL PLAZA RETIREMENT RESIDENCE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841324050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15520 NORTH WEST SECOND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-949-2626
Provider Business Mailing Address Fax Number:
305-940-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 MARGATE BLVD.
Provider Second Line Business Practice Location Address:
CORAL PLAZA RETIREMENT RESIDENCE, LLC
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-970-0053
Provider Business Practice Location Address Fax Number:
954-971-7961
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
305-949-2626

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  7861 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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