Provider Demographics
NPI:1225611809
Name:CARMITA'S CARE ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:CARMITA'S CARE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-797-9008
Mailing Address - Street 1:962 PINELAND DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3553
Mailing Address - Country:US
Mailing Address - Phone:407-797-9008
Mailing Address - Fax:
Practice Address - Street 1:962 PINELAND DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3553
Practice Address - Country:US
Practice Address - Phone:407-797-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility