MEDICARE: THE PROMISED LAND ALF INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1194297606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PROMISED LAND ALF INC

Provider Business Mailing Address
First Line	:	1041 NE PINE ISLAND LN
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2176
Country	:	US
Telephone Number	:	239-288-8502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 NE PINE ISLAND LN
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2176
Country	:	US
Telephone Number	:	239-288-8502
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALEXIS MATIAS
Credential	:	RN
Telephone Number	:	239-288-8502

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	06/17/2021

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Directions to “THE PROMISED LAND ALF INC ” Practice Location

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