Cristal Palace Resort PB, LLC.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12660 Issued in FL

Legal business name

CRISTAL PALACE RESORT PB, LLC.

Doing business as

Cristal Palace Resort PB LLC

Practice address

1881 Palm Bay Rd NE
Palm Bay, FL 32905-2978

Phone

(321) 951-2989

NPI assigned

May 14, 2015

Last updated

May 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Renea Phenix

Title

Administrator

Phone

(321) 951-2989

Specialties & licenses 1

Addresses

Other names 1

• Cristal Palace Resort PB LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adrian Eduardo Ail

  • Assisted Living Facility
  • Palm Bay, FL
  • NPI 1558987123
  NPD (past)

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431561600000",
    "number": "1235517988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 PALM BAY RD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052978",
            "telephone_number": "321-951-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1881 PALM BAY RD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052978",
            "telephone_number": "321-951-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISTAL PALACE RESORT PB, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2015-05-14",
        "status": "A",
        "authorized_official_last_name": "PHENIX",
        "authorized_official_first_name": "RENEA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-951-2989",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cristal Palace Resort PB LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen Cotton, PH.D.
• Robert Dennis Couch
• Lea Crabb, COTA/L
• Jennifer Elizabeth Crane, COTA/L
• Cynthia Withers Crawford
• CRM Health and Home Services LLC
• Luciano Cruz
• Csi Nurse World, Inc. (Help at Home)
• Lauren Cuculino, DMD
• Gino Cuello Guzman

• Assisted Living Facility in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; 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.