Provider Demographics
NPI:1205387180
Name:ALMARK GROVE ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:ALMARK GROVE ASSISTED LIVING FACILITY, LLC
Other - Org Name:ALMARK HEALTH SERVICES, # II
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEXUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-656-2443
Mailing Address - Street 1:13920 EYLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4664
Mailing Address - Country:US
Mailing Address - Phone:407-656-2443
Mailing Address - Fax:
Practice Address - Street 1:4502 ALMARK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1330
Practice Address - Country:US
Practice Address - Phone:407-816-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALMARK HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9874385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid