Provider Demographics
NPI:1366799413
Name:NORTH PALM SENIORS, INC.
Entity type:Organization
Organization Name:NORTH PALM SENIORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:LEIGHT
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-907-7172
Mailing Address - Street 1:11420 US HIGHWAY 1 # 172
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3226
Mailing Address - Country:US
Mailing Address - Phone:561-907-7172
Mailing Address - Fax:561-658-2949
Practice Address - Street 1:11420 US HIGHWAY 1 # 172
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3226
Practice Address - Country:US
Practice Address - Phone:561-907-7172
Practice Address - Fax:561-658-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty