Provider Demographics
NPI:1083145072
Name:EASTON'S PLACE LLC
Entity Type:Organization
Organization Name:EASTON'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:INDIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-603-5917
Mailing Address - Street 1:2301 W JAMES LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5409
Mailing Address - Country:US
Mailing Address - Phone:850-306-2618
Mailing Address - Fax:
Practice Address - Street 1:2301 W JAMES LEE BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5409
Practice Address - Country:US
Practice Address - Phone:850-306-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12975310400000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care