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General NPI Number Information
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NPI Number | 1265633762
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS ALF INC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5080 WAYSIDE DR
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City | SANFORD
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State | FL
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Zip | 32771-8613
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Country | US
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Telephone | 407-322-7118
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Fax | 407-322-7023
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Provider Business Mailing Address
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Address Line | 5080 WAYSIDE DR
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City | SANFORD
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State | FL
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Zip | 32771-8613
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Country | US
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Telephone | 407-322-7118
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Fax | 407-322-7023
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JOCELYN CARLOS
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Credential | BSN RN
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Telephone | 407-322-7118
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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 | AL 10150
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License Number State | FL
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