Christallis Manor III

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

CHRISTALLIS MANOR III

Practice address

420 N Riverside Dr
Pompano Beach, FL 33062-5035

Phone

(954) 274-5573

NPI assigned

Sep 3, 2020

Organization subpart

No

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

Authorized official

Name

Amparo M Dierking

Title

Administrator

Phone

(954) 274-5573

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beachside Living LLC Doing business as

Tax ID family

Beachside Living LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Christallis Manor III

  • Assisted Living Facility
  • Pompano Beach, FL
  • NPI 1386258218
  NPD tax ID

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1083228332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 N RIVERSIDE DR",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330625035",
            "telephone_number": "954-274-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N RIVERSIDE DR",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330625035",
            "telephone_number": "954-274-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTALLIS MANOR III",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-03",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "DIERKING",
        "authorized_official_first_name": "AMPARO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-274-5573"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107611700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beachside Living LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beachside Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Marie Chisolm
• Choices Network Systems, Inc
• Choices Network Systems, Inc.
• Nicole Chow-How, P.T.
• Choiti Chowdhry
• Christallis Manor III
• Michelle Wilburn Christian, M.S.
• Allison Leigh Christine, MS ED.
• Elizabeth Marie Christoe
• Mariia Chufarova

• Assisted Living Facility (Behavioral Disturbances) in Pompano Beach, FL
• Providers in Pompano Beach, FL by specialty
• Assisted Living Facility (Behavioral Disturbances) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.