Provider Demographics
NPI:1033838834
Name:GONZALEZ ADULT CARE FACILITIES LLC
Entity Type:Organization
Organization Name:GONZALEZ ADULT CARE FACILITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:YOANNERY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-246-2080
Mailing Address - Street 1:228 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3407
Mailing Address - Country:US
Mailing Address - Phone:561-720-2953
Mailing Address - Fax:561-228-0581
Practice Address - Street 1:228 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3407
Practice Address - Country:US
Practice Address - Phone:561-720-2953
Practice Address - Fax:561-228-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13736OtherAHCA