SHANGRI-LA OF PALM BAY ALF, LLC (NPI# 1447881297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447881297 |
| Entity Type | Organization |
| Organization Name | SHANGRI-LA OF PALM BAY ALF, LLC |
| Practice Address |
3604 Jupiter Blvd. Se Palm Bay FL 32909 |
| Mailing Address |
4975 Dixie Hwy Ne Unit 503 Palm Bay FL 32905-6083 |
| Practice Telephone | 9549378224 |
| Mailing Telephone | 3217288659 |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |
| Authorized Official Name | MRS. VERONIQUE MARIE STURM (OWNER MANAGER) |
| Authorized Official Telephone | 9549378224 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
3604 JUPITER BLVD. SE |
| City | PALM BAY |
| State | FL |
| Zip Code | 32909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447349 | Sarah Nicosia | Registered Nurse | 2752 Palisades Dr, Palm Bay, FL 32909 | 2020-08-12 |
| 1972094357 | Mindful Counseling and Wellness LLC | Social Worker | 221 Devlin Ct Se, Palm Bay, FL 32909 | 2018-05-22 |
| 1306348859 | Mallory Kathleen Herndon | Behavior Technician | 458 Barcelona Rd, Palm Bay, FL 32909 | 2018-03-01 |
| 1548786627 | Chotsani Merrill | Home Health Aide | 781 Davenport St Se, Palm Bay, FL 32909 | 2017-08-21 |
| 1639629538 | Maggie Cameron | Clinic/Center | 2511 Quentin Ave Ne, Palm Bay, FL 32909 | 2016-10-04 |
| 1194195016 | Dawn Goodwin | Pharmacist | 3450 Bayside Lakes Shopping Center, Palm Bay, FL 32909 | 2015-10-05 |
| 1124407796 | Jorge Ortiz | Physical Therapist | 470 Malabar Rd Se, Ste 102, Palm Bay, FL 32909 | 2015-05-28 |
| 1932506227 | Annalisa Tietjen I | Dental Hygienist | 714 Ave C, Fort Pierce, FL 32909 | 2014-12-02 |
| 1194147611 | Carl Glenmore Morrison Sr. | General Practice | 2125 Windbrook Drive, Palm Bay, FL 32909 | 2014-01-17 |
| 1366888422 | Kristie M Houle | Nurse Practitioner | 3238 Warsaw Ave, Palm Bay, FL 32909 | 2013-05-16 |
| Find all providers in zip 32909 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205787 | Pd & Sr, L.L.C. | Assisted Living Facility | 730 Frisco St Se, Palm Bay, FL 32909-3711 | 2020-11-06 |
| 1003423294 | Rome's Paradise Assisted Living II | Assisted Living Facility | 564 Delmonico St Ne, Palm Bay, FL 32907-3129 | 2020-09-30 |
| 1871136127 | Lucienne Cajuste Delva | Assisted Living Facility | 1246 Harlingen Rd Sw, Palm Bay, FL 32908-7146 | 2019-10-18 |
| 1811483290 | Welcome Home Assisted Living Facility LLC | Assisted Living Facility | 1387 San Cortez Ave Ne, Palm Bay, FL 32907-1118 | 2018-07-09 |
| 1851883706 | Tara Demetria Johnson | Assisted Living Facility | 226 Abalone Rd Nw, Palm Bay, FL 32907-2964 | 2018-06-05 |
| 1437640653 | Hannah's Home LLC | Assisted Living Facility | 997 Lyons Cir Nw, Palm Bay, FL 32907-5911 | 2018-05-23 |
| 1447756655 | Glenville Pines II Assisted Living Facility LLC | Assisted Living Facility | 211 Silver Oak Rd Ne, Palm Bay, FL 32907-5582 | 2018-04-05 |
| 1982107678 | Serenity Lifestyle Plus | Assisted Living Facility | 178 Evergreen St Ne, Palm Bay, FL 32907-1905 | 2018-03-09 |
| 1780113076 | Caring Manor LLC | Assisted Living Facility | 1863 Edith St Ne, Palm Bay, FL 32907 | 2017-06-08 |
| 1952836736 | Blue Fountain II Home Care, LLC. | Assisted Living Facility | 1310 Sequoia Rd Nw, Palm Bay, FL 32907-2780 | 2017-04-28 |
| Find all providers in PALM BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.