Provider Demographics
NPI:1255674131
Name:FRIENDS AT HOME ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:FRIENDS AT HOME ASSISTED LIVING INC.
Other - Org Name:FRIENDS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-631-4005
Mailing Address - Street 1:3680 CANAVERAL GROVES BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-6831
Mailing Address - Country:US
Mailing Address - Phone:321-626-6672
Mailing Address - Fax:
Practice Address - Street 1:3680 CANAVERAL GROVES BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-6831
Practice Address - Country:US
Practice Address - Phone:321-626-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9640310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility