Provider Demographics
NPI:1447318639
Name:ARCH PLAZA INC
Entity type:Organization
Organization Name:ARCH PLAZA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-891-1710
Mailing Address - Street 1:12505 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6019
Mailing Address - Country:US
Mailing Address - Phone:305-891-1710
Mailing Address - Fax:305-891-9180
Practice Address - Street 1:12505 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6019
Practice Address - Country:US
Practice Address - Phone:305-891-1710
Practice Address - Fax:305-891-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF10200961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-5008Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER