Provider Demographics
NPI:1225450604
Name:ALDERSGATE RETIREMENT INC.
Entity Type:Organization
Organization Name:ALDERSGATE RETIREMENT INC.
Other - Org Name:EPWORTH VILLAGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-3500
Mailing Address - Street 1:5300 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2104
Mailing Address - Country:US
Mailing Address - Phone:305-556-3500
Mailing Address - Fax:305-821-1407
Practice Address - Street 1:5300 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2104
Practice Address - Country:US
Practice Address - Phone:305-556-3500
Practice Address - Fax:305-821-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5839310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003136100Medicaid