Provider Demographics
NPI:1083051031
Name:TRANSITIONCARE ALF
Entity Type:Organization
Organization Name:TRANSITIONCARE ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:CELETA
Authorized Official - Last Name:MIHALOW
Authorized Official - Suffix:
Authorized Official - Credentials:7722246091
Authorized Official - Phone:772-224-6091
Mailing Address - Street 1:1613 SW MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4300
Mailing Address - Country:US
Mailing Address - Phone:772-408-6677
Mailing Address - Fax:
Practice Address - Street 1:1613 SW MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4300
Practice Address - Country:US
Practice Address - Phone:772-408-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA11948310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility