Healthcare Provider Details

I. General information

NPI: 1053573360
Provider Name (Legal Business Name): AASBURY ASSISTED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 SATEL DR
ORLANDO FL
32810-4414
US

IV. Provider business mailing address

5302 SATEL DR
ORLANDO FL
32810-4414
US

V. Phone/Fax

Practice location:
  • Phone: 407-522-4832
  • Fax: 407-522-7228
Mailing address:
  • Phone: 407-522-4832
  • Fax: 407-522-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10956
License Number StateFL

VIII. Authorized Official

Name: MRS. DIANNE RIVERS ANDERSON
Title or Position: SUPERVISOR
Credential:
Phone: 407-522-4832