Provider Demographics
NPI:1295000842
Name:SHANGRI-LA ALF, LLC
Entity Type:Organization
Organization Name:SHANGRI-LA ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LAPOINTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-914-0669
Mailing Address - Street 1:997 LYONS CIRCLE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-5911
Mailing Address - Country:US
Mailing Address - Phone:321-914-0669
Mailing Address - Fax:
Practice Address - Street 1:997 LYONS CIRCLE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-5911
Practice Address - Country:US
Practice Address - Phone:321-914-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12037310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003935300Medicaid