Provider Demographics
NPI:1568775898
Name:FOUR SEASONS ELDER CARE ALF, INC.
Entity Type:Organization
Organization Name:FOUR SEASONS ELDER CARE ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-877-2745
Mailing Address - Street 1:6625 MIAMI LAKEWAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2748
Mailing Address - Country:US
Mailing Address - Phone:786-877-2745
Mailing Address - Fax:305-397-1912
Practice Address - Street 1:6625 MIAMI LAKEWAY SOUTH
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2748
Practice Address - Country:US
Practice Address - Phone:786-877-2745
Practice Address - Fax:305-397-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11660310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002796000Medicaid