Organization
PALM COAST ALF MANAGEMENT LLC
Active
Other names
Gold Choice Palm Coast
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERICK WAYNE DEETER (MANAGER)
(407) 202-0046
Entity
Organization
Contact information
Practice address
3830 OLD KINGS ROAD, PALM COAST, FL 32137
(386) 307-5445
Mailing address
269 KIPLING CT, LAKE MARY, FL 32746-4124
(407) 202-0046
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110284500
—
FL
01
—
13591
ASSISTED LIVING FACILITY LICENSE
FL
Enumeration date
07/29/2020
Last updated
05/20/2021
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