Provider Demographics
NPI:1427231554
Name:AMBRAY AND LABAYNE CORP
Entity Type:Organization
Organization Name:AMBRAY AND LABAYNE CORP
Other - Org Name:DBA EUSTIS SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AMBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-589-8944
Mailing Address - Street 1:228 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3514
Mailing Address - Country:US
Mailing Address - Phone:352-589-8944
Mailing Address - Fax:352-589-0794
Practice Address - Street 1:228 N CENTER ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3514
Practice Address - Country:US
Practice Address - Phone:352-589-8944
Practice Address - Fax:352-589-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8993310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility