Provider Demographics
NPI:1285465880
Name:A & G MARVELOUS ALF LLC
Entity type:Organization
Organization Name:A & G MARVELOUS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNALISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-636-9168
Mailing Address - Street 1:6706 INWOOD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3820
Mailing Address - Country:US
Mailing Address - Phone:954-636-9168
Mailing Address - Fax:
Practice Address - Street 1:6706 INWOOD
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3820
Practice Address - Country:US
Practice Address - Phone:954-636-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility