Provider Demographics
NPI:1417481656
Name:A SENIOR LIVING DREAM LLC
Entity Type:Organization
Organization Name:A SENIOR LIVING DREAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:609-428-9360
Mailing Address - Street 1:13442 SW 284 TH STREET
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033
Mailing Address - Country:US
Mailing Address - Phone:786-786-3495
Mailing Address - Fax:305-602-8167
Practice Address - Street 1:13442 SW 284 TH STREET
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1942
Practice Address - Country:US
Practice Address - Phone:609-428-9360
Practice Address - Fax:305-602-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12831310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility