Provider Demographics
NPI:1235376930
Name:LIVING WELL ALF CORP
Entity Type:Organization
Organization Name:LIVING WELL ALF CORP
Other - Org Name:LIVING WELL ALF # 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GACEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-431-2586
Mailing Address - Street 1:21280 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3131
Mailing Address - Country:US
Mailing Address - Phone:305-431-2586
Mailing Address - Fax:305-229-0091
Practice Address - Street 1:21280 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3131
Practice Address - Country:US
Practice Address - Phone:305-431-2586
Practice Address - Fax:305-229-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11461310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility