Provider Demographics
NPI:1346807021
Name:BEAR ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BEAR ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-967-3808
Mailing Address - Street 1:2411 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3964
Mailing Address - Country:US
Mailing Address - Phone:813-967-3808
Mailing Address - Fax:407-348-0031
Practice Address - Street 1:2411 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3964
Practice Address - Country:US
Practice Address - Phone:813-967-3808
Practice Address - Fax:407-348-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102786300Medicaid