Provider Demographics
NPI:1477052637
Name:BRILLIANCE LIVING CORPORATION
Entity Type:Organization
Organization Name:BRILLIANCE LIVING CORPORATION
Other - Org Name:BRILLIANCE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RINU
Authorized Official - Middle Name:
Authorized Official - Last Name:ASWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-690-1709
Mailing Address - Street 1:2010 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-4253
Mailing Address - Country:US
Mailing Address - Phone:386-410-5145
Mailing Address - Fax:
Practice Address - Street 1:2010 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-4253
Practice Address - Country:US
Practice Address - Phone:386-410-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022573700Medicaid