Christallis Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL 12232 Issued in FL

Legal business name

CHRISTALLIS MANOR LLC

Practice address

2119 Wilson St
Hollywood, FL 33020-2648

Phone

(954) 921-0918

Fax

(954) 921-0917

NPI assigned

Apr 24, 2013

Organization subpart

No

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

Authorized official

Name

Miss Amparo Margot Dierking, RN

Title

Administrator

Phone

(954) 274-5573

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366761600000",
    "number": "1871937433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 WILSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330202648",
            "telephone_number": "954-921-0918",
            "fax_number": "954-921-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 WILSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330202648",
            "telephone_number": "954-921-0918",
            "fax_number": "954-921-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTALLIS MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-24",
        "last_updated": "2013-04-24",
        "status": "A",
        "authorized_official_last_name": "DIERKING",
        "authorized_official_first_name": "AMPARO",
        "authorized_official_middle_name": "MARGOT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-274-5573",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL 12232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Choice Health Care and Consulting Services, Inc.
• Tessy C Chorath, RPH
• Youssef Choucair, OD
• Chris William Akins MD PA
• Christallis Manor II LLC
• Logan Christensen, DO
• Christina Elkind, PA
• Christopher Brooks MD PA
• Zafar Ahmad Chuadry, M.D.
• Helen-Valentine Chukwu, D.O.

• Assisted Living Facility in Hollywood, FL
• Providers in Hollywood, 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 Apr 24, 2013; 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.