Basic Information
| Provider Information | |||||||||
| NPI: | 1629310420 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVANTE CARE OF HOLLYWOOD, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAJESTIC MEMORY CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE ELLENOR DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328094643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072160101 | ||||||||
| FaxNumber: | 4073182477 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 ARTHUR ST | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330193118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549265600 | ||||||||
| FaxNumber: | 9549268080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2013 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIEGASIEWICZ | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4072160101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3104A0625X | AL9201 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 009938300 | 05 | FL | MEDICAID |