Provider Demographics
NPI:1326388547
Name:INASMUCH ASSISTANT LIVING FACILITY, INC
Entity Type:Organization
Organization Name:INASMUCH ASSISTANT LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-438-7177
Mailing Address - Street 1:1007 W WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3766
Mailing Address - Country:US
Mailing Address - Phone:850-438-7177
Mailing Address - Fax:850-434-3363
Practice Address - Street 1:1007 W WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3766
Practice Address - Country:US
Practice Address - Phone:850-438-7177
Practice Address - Fax:850-434-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117503104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances