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General NPI Number Information
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NPI Number | 1891163481
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Entity Type | Organization
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Legal Business Name | LASALLE TLC ASSISTED LIVING LLC
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 09/13/2015
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Provider Practice Location Address
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Address Line | 585 ALLEN DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4990
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Country | US
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Telephone | 772-501-4756
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Fax | 321-806-4601
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Provider Business Mailing Address
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Address Line | 585 ALLEN DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4990
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Country | US
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Telephone | 772-501-4756
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Fax | 321-806-4601
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SALLY HAYES WILLIAMS
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Credential |
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Telephone | 772-501-4756
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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 | AL12721
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License Number State | FL
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