Organization
CHRISTALLIS MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS AMPARO MARGOT DIERKING RN (ADMINISTRATOR)
(954) 274-5573
Entity
Organization
Contact information
Practice address
2119 WILSON ST, HOLLYWOOD, FL 33020-2648
(954) 921-0918
(954) 921-0917
Mailing address
2119 WILSON ST, HOLLYWOOD, FL 33020-2648
(954) 921-0918
(954) 921-0917
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL 12232
FL
Other
Enumeration date
04/24/2013
Last updated
04/24/2013
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