Provider Demographics
NPI:1417251802
Name:LAKEVIEW ALF, CORP.
Entity Type:Organization
Organization Name:LAKEVIEW ALF, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-387-4063
Mailing Address - Street 1:14220 KENDALE LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3923
Mailing Address - Country:US
Mailing Address - Phone:305-387-4063
Mailing Address - Fax:305-387-4063
Practice Address - Street 1:14220 KENDALE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3923
Practice Address - Country:US
Practice Address - Phone:305-387-4063
Practice Address - Fax:305-387-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11659310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001601900Medicaid