Provider Demographics
NPI:1497424741
Name:L & G ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:L & G ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-676-1866
Mailing Address - Street 1:13341 SW 272ND LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8585
Mailing Address - Country:US
Mailing Address - Phone:305-676-1866
Mailing Address - Fax:305-998-5519
Practice Address - Street 1:13341 SW 272ND LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8585
Practice Address - Country:US
Practice Address - Phone:305-676-1866
Practice Address - Fax:305-998-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13640OtherAHCA