Organization
SILVER SPARKS RESIDENTIAL CARE LLC DBA ADULT LEISURE LIVING
Active
Other names
ADULT LEISURE LIVING
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAVERN MARIE GORDON THOMAS (ADMINISTRATOR)
(786) 506-6778
Entity
Organization
Contact information
Practice address
15650 W BUNCHE PARK DR, MIAMI GARDENS, FL 33054-6965
(305) 705-2347
Mailing address
15650 W BUNCHE PARK DR, MIAMI GARDENS, FL 33054-6965
(305) 705-2347
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12063
AGENCY FOR HEALTHCARE ADMINISTRATION LICENSE
FL
Enumeration date
02/22/2023
Last updated
02/22/2023
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