Provider Demographics
NPI:1346499720
Name:AC PANMAR, INC
Entity Type:Organization
Organization Name:AC PANMAR, INC
Other - Org Name:FOUR SEASONS ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARASIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-322-7118
Mailing Address - Street 1:5080 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8613
Mailing Address - Country:US
Mailing Address - Phone:407-322-7118
Mailing Address - Fax:407-322-7023
Practice Address - Street 1:5080 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8613
Practice Address - Country:US
Practice Address - Phone:407-322-7118
Practice Address - Fax:407-322-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10150310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693118900Medicaid