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Organization
2065 INC DBA FORT LAUDERDALE RETIREMENT HOME
Active
Organization
2065 INC DBA FORT LAUDERDALE RETIREMENT HOME
Active
Other names
FORT LAUDERDALE RETIREMENT HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE HENRY HEATH RN,BSN (ADMINISTRATOR/OWNER)
(954) 270-6322
Entity
Organization
Contact information
Practice address
401 SE 12TH CT, FORT LAUDERDALE, FL 33316-1919
(954) 270-6322
(954) 423-1674
Mailing address
401 SE 12TH CT, FORT LAUDERDALE, FL 33316-1919
(954) 270-6322
(954) 423-1674
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
ALF6634
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140290100
—
FL
Enumeration date
04/07/2014
Last updated
04/07/2014
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