Provider Demographics
NPI:1558720847
Name:JUBILEE ASSISTED LIVING OF FLORIDA, LLC
Entity Type:Organization
Organization Name:JUBILEE ASSISTED LIVING OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCARDEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-394-9118
Mailing Address - Street 1:16639 REDWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1512
Mailing Address - Country:US
Mailing Address - Phone:954-394-9118
Mailing Address - Fax:954-944-1976
Practice Address - Street 1:16639 REDWOOD WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1512
Practice Address - Country:US
Practice Address - Phone:954-394-9118
Practice Address - Fax:954-944-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12901OtherAHCA