Organization
PEMBROOK PLACE 2, INC.
Active
Other names
Pembrook Place II Assisted Living Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MONTECLARO (PRESIDENT/ADMINISTRATOR)
(727) 656-2245
Entity
Organization
Contact information
Practice address
1623 ROBINHOOD LN, CLEARWATER, FL 33764-6447
(727) 539-6872
(727) 213-9068
Mailing address
PO BOX 7619, CLEARWATER, FL 33758-7619
(727) 656-2245
(727) 213-9068
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7581
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005240000
MEDICAID PROVIDER NO.
FL
Enumeration date
03/07/2014
Last updated
03/07/2014
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