Provider Demographics
NPI:1558978049
Name:HOLY SPIRIT ASSISTED LIVING HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HOLY SPIRIT ASSISTED LIVING HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:MIRADELLE
Authorized Official - Last Name:AUGUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-503-3719
Mailing Address - Street 1:280 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3605
Mailing Address - Country:US
Mailing Address - Phone:321-848-0255
Mailing Address - Fax:888-335-7714
Practice Address - Street 1:280 BAHAMA DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3605
Practice Address - Country:US
Practice Address - Phone:321-848-0255
Practice Address - Fax:888-335-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility