Provider Demographics
NPI:1518436542
Name:COASTAL LIVING LLC DBA BANANA RIVER VILLAS ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:COASTAL LIVING LLC DBA BANANA RIVER VILLAS ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-454-9528
Mailing Address - Street 1:1275 N BANANA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5757
Mailing Address - Country:US
Mailing Address - Phone:321-454-9528
Mailing Address - Fax:321-454-9528
Practice Address - Street 1:1275 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5757
Practice Address - Country:US
Practice Address - Phone:321-454-9528
Practice Address - Fax:321-454-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility