Provider Demographics
NPI:1275760217
Name:VALLE CORP
Entity Type:Organization
Organization Name:VALLE CORP
Other - Org Name:SAND LAKE ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:321-303-7702
Mailing Address - Street 1:1013 CRYSTAL BAY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6636
Mailing Address - Country:US
Mailing Address - Phone:321-303-7702
Mailing Address - Fax:
Practice Address - Street 1:807 NANA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5913
Practice Address - Country:US
Practice Address - Phone:407-854-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11561310400000X
FLAL 115613104A0625X, 314000000X, 315D00000X, 385H00000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care