Organization
NIC 4 THE PLAZA LEASING LLC
Active
Other names
The Plaza at Pembroke Park
Organization subpart
No
Provider details
NPI number
Authorized official
JANE RYU (PRESIDENT/CEO/CFO)
(212) 479-5270
Entity
Organization
Contact information
Practice address
3535 SW 52ND AVE., PEMBROKE PARK, FL 33801
(954) 961-8111
(954) 964-2871
Mailing address
PO BOX 1700, NIC 4 THE PLAZA LEASING LLC, C/O HOLIDAY RETIREMENT, LAKE OSWEGO, OR 97035
(971) 245-8020
(503) 431-2295
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5120
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0047736
HOME & COMMUNITY BASED SERVICES
FL
Enumeration date
04/29/2013
Last updated
12/01/2016
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