Provider Demographics
NPI:1124554993
Name:ALCIME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ALCIME ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN-CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCIME
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:603-231-9263
Mailing Address - Street 1:450 SW VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1973
Mailing Address - Country:US
Mailing Address - Phone:603-231-9263
Mailing Address - Fax:877-310-8660
Practice Address - Street 1:450 SW VIOLET AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1973
Practice Address - Country:US
Practice Address - Phone:603-231-9263
Practice Address - Fax:877-310-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12736310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016038100Medicaid