Provider Demographics
NPI:1073946901
Name:AIROSO PLACE ALF LLC
Entity Type:Organization
Organization Name:AIROSO PLACE ALF LLC
Other - Org Name:NO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BENELDENA
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-263-5274
Mailing Address - Street 1:1802 SW AIROSO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3703
Mailing Address - Country:US
Mailing Address - Phone:954-263-5274
Mailing Address - Fax:772-249-4338
Practice Address - Street 1:1802 SW AIROSO BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3703
Practice Address - Country:US
Practice Address - Phone:954-263-5274
Practice Address - Fax:772-249-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12387310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility