Provider Demographics
NPI:1396119004
Name:MAJESTIC ON THE RIVER LLC
Entity type:Organization
Organization Name:MAJESTIC ON THE RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISRAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-266-4015
Mailing Address - Street 1:7200 W CAMINO REAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5511
Mailing Address - Country:US
Mailing Address - Phone:954-266-4015
Mailing Address - Fax:954-839-6229
Practice Address - Street 1:408 SW 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2567
Practice Address - Country:US
Practice Address - Phone:954-266-4015
Practice Address - Fax:954-839-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66283104A0625X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6628OtherLICENCE