Provider Demographics
NPI:1366823734
Name:MILA ALF, LLC
Entity Type:Organization
Organization Name:MILA ALF, LLC
Other - Org Name:DIXIE LODGE ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:YUZEFPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-325-1963
Mailing Address - Street 1:17555 COLLINS AVE.,
Mailing Address - Street 2:SUITE 1808
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2888
Mailing Address - Country:US
Mailing Address - Phone:786-325-1963
Mailing Address - Fax:
Practice Address - Street 1:647 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5810
Practice Address - Country:US
Practice Address - Phone:386-734-4830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10773104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness