Organization
PALM LAKE VILLAGE HOUSING CORPORATION
Active
Other names
Magnolia Gardens
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ELLIOTT (ADMINISTRATOR)
(727) 489-6440
Entity
Organization
Contact information
Practice address
3800 62ND AVE N, PINELLAS PARK, FL 33781-6055
(727) 489-6440
Mailing address
3800 62ND AVE N, PINELLAS PARK, FL 33781-6055
(727) 489-6440
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10314
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001645100
—
FL
Enumeration date
01/28/2013
Last updated
09/05/2019
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