=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528330008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICARE COMMUNITIES FLORIDA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2012
-----------------------------------------------------
Last Update Date | 01/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 SUN N LAKE BLVD
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33872-2175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-386-1060
-----------------------------------------------------
Fax | 863-386-4925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1836 S PATRIOT DR
-----------------------------------------------------
City | YORKTOWN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47396-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-759-0230
-----------------------------------------------------
Fax | 765-759-0240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. LARRY M NEW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-759-0230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9756
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------