MEDICARE: JUST LIKE FAMILY ASSISTED LIVING FACILITY

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	305R00000X	Preferred Provider Organization	AL12656	FL

General Provider Information

NPI Number	:	1790162261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST LIKE FAMILY ASSISTED LIVING FACILITY

Provider Business Mailing Address
First Line	:	1144 SATURN ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-9230
Country	:	US
Telephone Number	:	754-422-1640
Fax Number	:	321-400-1040

Provider Business Practice Location Address
First Line	:	1144 SATURN ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-9230
Country	:	US
Telephone Number	:	754-422-1640
Fax Number	:	321-400-1040

Authorized Official
Title or Position	:	OWNER
Name	:	SOHANNE WESTON
Credential	:
Telephone Number	:	754-422-1640

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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