NPIMap

Organization Active NPI

Nic 4 the Plaza Leasing LLC

Doing business as The Plaza at Pembroke Park

  • Assisted Living Facility
  • Pembroke Park, FL
National Provider Identifier
1659715027
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5120 Issued in FL
Legal business name
NIC 4 THE PLAZA LEASING LLC
Doing business as
The Plaza at Pembroke Park
Practice address
3535 SW 52ND Ave.
Pembroke Park, FL 33801
Phone
(954) 961-8111
Fax
(954) 964-2871
NPI assigned
Apr 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

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

Authorized official

Name
Jane Ryu
Title
President/Ceo/Cfo
Phone
(212) 479-5270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5120 FL Primary

Addresses

Primary practice location

3535 SW 52ND Ave.
Pembroke Park, FL 33801

Mailing address

PO Box 1700, Nic 4 the Plaza Leasing LLC
C/O Holiday Retirement
Lake Oswego, OR 97035
Phone (971) 245-8020

Other identifiers 1

IdentifierTypeStateIssuer
0047736OtherFLHOME & COMMUNITY BASED SERVICES

Other names 1

  • The Plaza at Pembroke Park Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1659715027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700, NIC 4 THE PLAZA LEASING LLC",
            "address_2": "C/O HOLIDAY RETIREMENT",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "971-245-8020",
            "fax_number": "503-431-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SW 52ND AVE.",
            "city": "PEMBROKE PARK",
            "state": "FL",
            "postal_code": "33801",
            "telephone_number": "954-961-8111",
            "fax_number": "954-964-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 4 THE PLAZA LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "212-479-5270"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "5120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME & COMMUNITY BASED SERVICES",
            "identifier": "0047736",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Plaza at Pembroke Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.