Provider Demographics
NPI:1578801866
Name:BEACON VILLA ALF OPERATING LLC
Entity Type:Organization
Organization Name:BEACON VILLA ALF OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-809-6147
Mailing Address - Street 1:141 KAELYN LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-6180
Mailing Address - Country:US
Mailing Address - Phone:850-647-4000
Mailing Address - Fax:850-647-4004
Practice Address - Street 1:141 KAELYN LN
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-6180
Practice Address - Country:US
Practice Address - Phone:850-647-4000
Practice Address - Fax:850-647-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility