MEDICARE: KINDHEARTED ASSISTED LIVING FACILITY, 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	AL11530	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	:	1922396431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDHEARTED ASSISTED LIVING FACILITY, INC.

Provider Business Mailing Address
First Line	:	2815 CLEVELAND HEIGHTS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4107
Country	:	US
Telephone Number	:	863-178-4800
Fax Number	:	863-578-3017

Provider Business Practice Location Address
First Line	:	2815 CLEVELAND HEIGHTS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4107
Country	:	US
Telephone Number	:	863-248-3038
Fax Number	:	863-578-4800

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. YOLENE MILHOMME
Credential	:	RN
Telephone Number	:	863-578-5800

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	04/16/2015

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