Provider Demographics
NPI:1992141972
Name:PALMETTO COURT ALF OF VENICE, INC
Entity type:Organization
Organization Name:PALMETTO COURT ALF OF VENICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-486-1415
Mailing Address - Street 1:513 MENENDEZ ST
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2233
Mailing Address - Country:US
Mailing Address - Phone:941-486-1415
Mailing Address - Fax:941-488-5612
Practice Address - Street 1:513 MENENDEZ ST
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2233
Practice Address - Country:US
Practice Address - Phone:941-486-1415
Practice Address - Fax:941-488-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8053310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility