NPIMap

Organization Active NPI

Coolidge Palms Assisted Living Resort

  • Assisted Living Facility
  • Hollywood, FL
National Provider Identifier
1093093775
Registry record updated Jul 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
12022 Issued in FL
Legal business name
COOLIDGE PALMS ASSISTED LIVING RESORT
Practice address
2057 Coolidge St
Hollywood, FL 33020-2427
Phone
(954) 266-4015
NPI assigned
Jul 28, 2011
Last updated
Jul 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2011

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

Authorized official

Name
Mr. Bruce Ellenbogen
Title
Administrator
Phone
(954) 266-4015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 12022 FL Primary

Addresses

Primary practice location

2057 Coolidge St
Hollywood, FL 33020-2427

Mailing address

2057 Coolidge St
Hollywood, FL 33020-2427

National Provider Directory

National Provider Directory
Tax ID family
Coolidge Palms Assisted Living Resort2 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.

NPI Registry JSON

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

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311811200000",
    "number": "1093093775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2057 COOLIDGE ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330202427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2057 COOLIDGE ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330202427",
            "telephone_number": "954-266-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOLIDGE PALMS ASSISTED LIVING RESORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-28",
        "last_updated": "2011-07-28",
        "status": "A",
        "authorized_official_last_name": "ELLENBOGEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-266-4015",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.