MEDICARE: SHANGRI-LA II ALF LLC

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	AL12136	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497021372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANGRI-LA II ALF LLC

Provider Business Mailing Address
First Line	:	1212 CORAL REEF AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8049
Country	:	US
Telephone Number	:	321-914-0301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 CORAL REEF AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8049
Country	:	US
Telephone Number	:	321-914-0301
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ERNEST ROGER LAPOINTE
Credential	:
Telephone Number	:	321-507-8722

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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