Provider Demographics
NPI:1003204454
Name:ASSURED CARE ALF
Entity Type:Organization
Organization Name:ASSURED CARE ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-672-9474
Mailing Address - Street 1:12209 MATCHFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4027
Mailing Address - Country:US
Mailing Address - Phone:813-239-7558
Mailing Address - Fax:813-672-9474
Practice Address - Street 1:12209 MATCHFIELD WAY
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4027
Practice Address - Country:US
Practice Address - Phone:813-239-7558
Practice Address - Fax:813-672-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12602310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility