Christallis Manor III

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CHRISTALLIS MANOR III

Doing business as

Beachside Living LLC

Practice address

420 N Riverside Dr
Pompano Beach, FL 33062-5035

Phone

(954) 274-5573

NPI assigned

Sep 8, 2020

Last updated

Sep 8, 2020By 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

Amparo Dierking

Title

Owner

Phone

(954) 274-5573

Specialties & licenses 1

Addresses

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

  dba Beachside Living LLC

  • Assisted Living Facility (Behavioral Disturbances)
  • Pompano Beach, FL
  • NPI 1083228332
  NPD tax ID

Locations

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1386258218",
    "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": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "DIERKING",
        "authorized_official_first_name": "AMPARO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-274-5573"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beachside Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Choices Network Systems, Inc (Choices Children and Families Consortium)
• Choices Network Systems, Inc.
• Nicole Chow-How, P.T.
• Choiti Chowdhry
• Christallis Manor III (Beachside Living LLC)
• Michelle Wilburn Christian, M.S.
• Allison Leigh Christine, MS ED.
• Elizabeth Marie Christoe
• Mariia Chufarova
• Heidi Beth Churgin, AP

• Assisted Living Facility in Pompano Beach, FL
• Providers in Pompano Beach, 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 Sep 8, 2020; 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.