Provider Demographics
NPI:1609629658
Name:SHANGRI-LA AT RIVIERA ALF LLC
Entity Type:Organization
Organization Name:SHANGRI-LA AT RIVIERA ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LAPOINTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-507-8722
Mailing Address - Street 1:132 ASCEND CIR UNIT 9103
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8751
Mailing Address - Country:US
Mailing Address - Phone:321-507-8722
Mailing Address - Fax:321-821-1395
Practice Address - Street 1:868 RIVIERA DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4438
Practice Address - Country:US
Practice Address - Phone:321-327-5458
Practice Address - Fax:321-676-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility