Provider Demographics
NPI:1003223009
Name:SWEET ALICE'S PLACE INC
Entity Type:Organization
Organization Name:SWEET ALICE'S PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANTE'
Authorized Official - Middle Name:
Authorized Official - Last Name:URSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-860-9621
Mailing Address - Street 1:3545 RAYMUR VILLA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-0907
Mailing Address - Country:US
Mailing Address - Phone:904-860-9621
Mailing Address - Fax:904-743-8211
Practice Address - Street 1:2317 W 25TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-3511
Practice Address - Country:US
Practice Address - Phone:904-860-9621
Practice Address - Fax:904-743-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12521310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility