Organization
INDEPENDENCE HALL OPERATOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS MICHAEL RABOLD JR. (MANAGING PARTNER)
(954) 496-0387
Entity
Organization
Contact information
Practice address
1639 NE 26TH ST, WILTON MANORS, FL 33305-1410
(954) 563-6232
Mailing address
215 N NEW RIVER DR E APT 1600, FORT LAUDERDALE, FL 33301-1091
(954) 496-0387
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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