Provider Demographics
NPI:1497939417
Name:AMWIL ASSISTED LIVING
Entity Type:Organization
Organization Name:AMWIL ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIETTA
Authorized Official - Middle Name:BANCOLITA
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-943-4606
Mailing Address - Street 1:840 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8214
Mailing Address - Country:US
Mailing Address - Phone:954-943-4606
Mailing Address - Fax:954-943-5016
Practice Address - Street 1:840 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8214
Practice Address - Country:US
Practice Address - Phone:954-943-4606
Practice Address - Fax:954-943-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9975302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization