Hollywood Beach Retirement Home

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL5026 Issued in FL

Legal business name

HOLLYWOOD BEACH RETIREMENT HOME

Practice address

1722 Madison St
Hollywood, FL 33020-5537

Phone

(954) 923-1726

Fax

(954) 923-8535

NPI assigned

Aug 11, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ricki Kaneti

Title

Administrator

Phone

(954) 923-1726

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1033498746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 MADISON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330205537",
            "telephone_number": "954-923-1726",
            "fax_number": "954-923-8535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 MADISON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330205537",
            "telephone_number": "954-923-1726",
            "fax_number": "954-923-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLYWOOD BEACH RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "KANETI",
        "authorized_official_first_name": "RICKI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-923-1726",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL5026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140923900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holistic Licensed Behavioral Analysts LLC
• Breonna Elizabeth Holland, MD
• Hollywood Accident & Injury Center LLC
• Hollywood Artificial Kidney Center LTD
• Hollywood Beach Recovery
• Hollywood Birth Center
• Hollywood Birth Center (HBC Midwives)
• Hollywood Chiromed Centers (South Florida Spine and Rehab Centers)
• Hollywood Chiropractic Clinic Inc
• Hollywood Comprehensive Rehabilitation Facilities Inc

• Assisted Living Facility (Mental Illness) in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.