Provider Demographics
NPI:1144563016
Name:A PLACE LIKE HOME, ALF
Entity Type:Organization
Organization Name:A PLACE LIKE HOME, ALF
Other - Org Name:A PLACE LIKE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-693-3325
Mailing Address - Street 1:6655 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-2221
Mailing Address - Country:US
Mailing Address - Phone:321-693-3325
Mailing Address - Fax:321-956-7571
Practice Address - Street 1:1971 PORT MALABAR BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5436
Practice Address - Country:US
Practice Address - Phone:321-693-3325
Practice Address - Fax:321-821-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11499310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility