Palms Villa Retirement Home, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL4990 Issued in FL

Legal business name

PALMS VILLA RETIREMENT HOME, INC.

Doing business as

Palms Villa
Palms Villa Retirement Home

Practice address

2131 NW 28TH St
Oakland Park, FL 33311-2136

Phone

(954) 484-1350

Fax

(954) 527-0505

NPI assigned

Oct 10, 2008

Organization subpart

No

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

Authorized official

Name

Jason Kissoonlal

Title

President

Phone

(954) 484-1350

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Palms Villa Doing business as
• Palms Villa Retirement Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1083866818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 NW 28TH ST",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333112136",
            "telephone_number": "954-484-1350",
            "fax_number": "954-527-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 NW 28TH ST",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333112136",
            "telephone_number": "954-484-1350",
            "fax_number": "954-527-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMS VILLA RETIREMENT HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-10",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "KISSOONLAL",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-484-1350"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL4990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140622100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palms Villa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palms Villa Retirement Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Mental Illness) in Oakland Park, FL
• Providers in Oakland Park, 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 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.