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General NPI Number Information
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NPI Number | 1023424405
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Entity Type | Organization
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Legal Business Name | AUTUMN BREEZE ASSISTED LIVING FACILITY INC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 904 LAKE MARTHA DR NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4278
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Country | US
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Telephone | 863-292-0780
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Fax | 863-291-0808
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Provider Business Mailing Address
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Address Line | 904 LAKE MARTHA DR NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4278
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Country | US
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Telephone | 863-292-0780
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Fax | 863-291-0808
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Authorized Official
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Title or Position | OWNER
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Name | MARIE POSSIBLE
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Credential |
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Telephone | 863-242-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11309
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License Number State | FL
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