Provider Demographics
NPI:1598943607
Name:LAKE ALFRED ASSISTED LIVING AND RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:LAKE ALFRED ASSISTED LIVING AND RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNULFO
Authorized Official - Middle Name:SALGADO
Authorized Official - Last Name:SIMONDAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-956-8831
Mailing Address - Street 1:350 W HAINES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2718
Mailing Address - Country:US
Mailing Address - Phone:863-956-8831
Mailing Address - Fax:863-956-9141
Practice Address - Street 1:3101 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-4365
Practice Address - Country:US
Practice Address - Phone:407-963-8777
Practice Address - Fax:407-568-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10511310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility