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General NPI Number Information
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NPI Number | 1306189014
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Entity Type | Organization
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Legal Business Name | A.L.F. AT OCEAN BREEZE GARDENS
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 535 JACKSON AVE
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-2929
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Country | US
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Telephone | 321-610-7056
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Fax | 321-989-0207
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Provider Business Mailing Address
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Address Line | PO BOX 372068
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-0068
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Country | US
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Telephone | 321-610-7056
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Fax | 321-989-0207
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KALEI STOCKSTILL
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Credential |
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Telephone | 321-591-4113
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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 | 11569
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License Number State | FL
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