Organization
CHRISTALLIS MANOR II LLC
Active
Other names
Christallis Manor II LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMPARO M DIERKING (OWNER)
(954) 274-5573
Entity
Organization
Contact information
Practice address
819 N 31ST CT, HOLLYWOOD, FL 33021-6111
(954) 274-5573
Mailing address
819 N 31ST CT, HOLLYWOOD, FL 33021-6111
(954) 274-5573
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107176600
—
FL
Enumeration date
07/06/2020
Last updated
10/01/2021
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