Provider Demographics
NPI:1558661199
Name:BERNADETTE ACLF, INC
Entity Type:Organization
Organization Name:BERNADETTE ACLF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-454-0826
Mailing Address - Street 1:520 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3306
Mailing Address - Country:US
Mailing Address - Phone:954-454-0826
Mailing Address - Fax:954-454-5143
Practice Address - Street 1:520 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3306
Practice Address - Country:US
Practice Address - Phone:954-454-0826
Practice Address - Fax:954-454-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140173400Medicaid
FL140173400Medicaid