Provider Demographics
NPI:1033416466
Name:SENIOR GRACES LLC
Entity Type:Organization
Organization Name:SENIOR GRACES LLC
Other - Org Name:HEART OF FLORIDA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GASMENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-595-7353
Mailing Address - Street 1:747 BON AIR ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4631
Mailing Address - Country:US
Mailing Address - Phone:863-688-1196
Mailing Address - Fax:863-687-7707
Practice Address - Street 1:301 S 10TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5601
Practice Address - Country:US
Practice Address - Phone:863-421-9581
Practice Address - Fax:863-422-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL#9965310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility