Healthcare Provider Details

I. General information

NPI: 1972741874
Provider Name (Legal Business Name): THE ISLANDS ALF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N HIAWASSEE RD
ORLANDO FL
32818-6708
US

IV. Provider business mailing address

10635 VIA DEL SOL
ORLANDO FL
32817-3369
US

V. Phone/Fax

Practice location:
  • Phone: 407-523-3000
  • Fax: 407-523-3008
Mailing address:
  • Phone: 407-678-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL4690
License Number StateFL

VIII. Authorized Official

Name: MRS. BENECIA BAGUHIN MANALO
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-523-3000