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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