Provider Demographics
NPI:1265833131
Name:PAMPERED PARENTS, ALF, INC.
Entity Type:Organization
Organization Name:PAMPERED PARENTS, ALF, INC.
Other - Org Name:PAMPERED PARENTS, ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:SANFORD
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:407-256-6070
Mailing Address - Street 1:3600 S OCEANSHORE BLVD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4100
Mailing Address - Country:US
Mailing Address - Phone:407-256-6070
Mailing Address - Fax:386-313-1676
Practice Address - Street 1:6 SETON CT
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4430
Practice Address - Country:US
Practice Address - Phone:386-313-6428
Practice Address - Fax:386-313-1679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAMPERED PARENTS, ALF, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12487310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12487OtherAHCA LICENSE