MEDICARE: ASSISTED LIVING SWEET INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL 11629	FL

General Provider Information

NPI Number	:	1134454275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING SWEET INC

Provider Business Mailing Address
First Line	:	5224 NE 3RD AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1685
Country	:	US
Telephone Number	:	305-345-6919
Fax Number	:	305-345-6919

Provider Business Practice Location Address
First Line	:	5224 NE 3RD AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1685
Country	:	US
Telephone Number	:	305-345-6919
Fax Number	:	305-345-6919

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY A LINCOLN
Credential	:
Telephone Number	:	305-345-6919

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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