Organization
GOD'S VIP SENIOR HAVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PETRAS (COO)
(260) 797-9482
Entity
Organization
Contact information
Practice address
4681 SW 66TH AVE, DAVIE, FL 33314-4340
(954) 581-9111
Mailing address
3630 ILLINOIS RD, FORT WAYNE, IN 46804-2062
(708) 309-0864
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5448
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5448
AHCA
FL
Enumeration date
03/21/2018
Last updated
03/21/2018
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