Provider Demographics
NPI:1538681705
Name:KLECKLEY FAMILY ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:KLECKLEY FAMILY ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLECKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-792-3610
Mailing Address - Street 1:93 SE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-7667
Mailing Address - Country:US
Mailing Address - Phone:352-505-5000
Mailing Address - Fax:
Practice Address - Street 1:93 SE 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7667
Practice Address - Country:US
Practice Address - Phone:352-505-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility