Provider Demographics
NPI:1508298860
Name:LINDENLEA ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:LINDENLEA ASSISTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-740-9117
Mailing Address - Street 1:1180 JACKSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7900
Mailing Address - Country:US
Mailing Address - Phone:386-740-9117
Mailing Address - Fax:386-490-4889
Practice Address - Street 1:1180 JACKSON RANCH RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724
Practice Address - Country:US
Practice Address - Phone:386-740-9117
Practice Address - Fax:386-490-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11216310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility