Provider Demographics
NPI:1346492121
Name:FLORIDA SHORES ASSISTED LIVING FACILITY INC.
Entity Type:Organization
Organization Name:FLORIDA SHORES ASSISTED LIVING FACILITY INC.
Other - Org Name:FLORIDA SHORES OF EDGEWATER ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISABELO
Authorized Official - Middle Name:
Authorized Official - Last Name:NUDALO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-428-5370
Mailing Address - Street 1:1229 MANGO TREE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-2005
Mailing Address - Country:US
Mailing Address - Phone:386-428-5370
Mailing Address - Fax:386-428-5370
Practice Address - Street 1:1229 MANGO TREE DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2005
Practice Address - Country:US
Practice Address - Phone:386-428-5370
Practice Address - Fax:386-428-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-11
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8229310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility