Provider Demographics
NPI:1194948307
Name:JORDAN BROOKE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:JORDAN BROOKE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUCASADA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-322-4112
Mailing Address - Street 1:4508 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7242
Mailing Address - Country:US
Mailing Address - Phone:954-322-4112
Mailing Address - Fax:954-322-4199
Practice Address - Street 1:4508 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7242
Practice Address - Country:US
Practice Address - Phone:954-322-4112
Practice Address - Fax:954-322-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility