Provider Demographics
NPI:1205179116
Name:CENTRAL FLORIDA SENIOR LIVING LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA SENIOR LIVING LLC
Other - Org Name:GOLDEN POND COMMUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:DION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-654-7217
Mailing Address - Street 1:402 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3019
Mailing Address - Country:US
Mailing Address - Phone:407-654-7217
Mailing Address - Fax:
Practice Address - Street 1:402 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3019
Practice Address - Country:US
Practice Address - Phone:407-654-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9626305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service