Provider Demographics
NPI:1033618145
Name:A & B LIFESTYLE LIVING
Entity Type:Organization
Organization Name:A & B LIFESTYLE LIVING
Other - Org Name:LEISURE MANOR OF LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ARCENAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-857-6410
Mailing Address - Street 1:5552 SW 93RD LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-9580
Mailing Address - Country:US
Mailing Address - Phone:352-857-6410
Mailing Address - Fax:352-509-3046
Practice Address - Street 1:301 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7436
Practice Address - Country:US
Practice Address - Phone:352-857-6410
Practice Address - Fax:352-509-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5456310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5456OtherAHCA LIC NUMBER