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General NPI Number Information
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NPI Number | 1194297606
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Entity Type | Organization
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Legal Business Name | THE PROMISED LAND ALF INC
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1041 NE PINE ISLAND LN
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City | CAPE CORAL
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State | FL
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Zip | 33909-2176
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Country | US
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Telephone | 239-288-8502
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 NE PINE ISLAND LN
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City | CAPE CORAL
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State | FL
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Zip | 33909-2176
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Country | US
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Telephone | 239-288-8502
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALEXIS MATIAS
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Credential | RN
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Telephone | 239-288-8502
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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 |
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License Number State |
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