Provider Demographics
NPI:1407157951
Name:OKEECHOBEE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:OKEECHOBEE ASSISTED LIVING LLC
Other - Org Name:THE HERITAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-763-1700
Mailing Address - Street 1:608 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2622
Mailing Address - Country:US
Mailing Address - Phone:863-763-1700
Mailing Address - Fax:
Practice Address - Street 1:608 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2622
Practice Address - Country:US
Practice Address - Phone:863-763-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11896310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility