Provider Demographics
NPI:1417177684
Name:CATALINA GARDENS HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CATALINA GARDENS HEALTH CARE ASSOCIATES LLC
Other - Org Name:BROOKSHIRE, THE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:85 BULLDOG BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3319
Mailing Address - Country:US
Mailing Address - Phone:321-984-7966
Mailing Address - Fax:321-984-8101
Practice Address - Street 1:85 BULLDOG BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3319
Practice Address - Country:US
Practice Address - Phone:321-984-7966
Practice Address - Fax:321-984-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7354310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693113800Medicaid