Provider Demographics
NPI:1275901605
Name:CARING HOUSE ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:CARING HOUSE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-531-9045
Mailing Address - Street 1:3090 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9495
Mailing Address - Country:US
Mailing Address - Phone:904-531-9045
Mailing Address - Fax:904-531-9045
Practice Address - Street 1:3090 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9495
Practice Address - Country:US
Practice Address - Phone:904-531-9045
Practice Address - Fax:904-531-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12453310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility