Provider Demographics
NPI:1619143682
Name:ANDREA CAINE
Entity Type:Organization
Organization Name:ANDREA CAINE
Other - Org Name:SWEET HOME AT LAST ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-532-2392
Mailing Address - Street 1:1580 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5671
Mailing Address - Country:US
Mailing Address - Phone:386-532-2392
Mailing Address - Fax:
Practice Address - Street 1:1580 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5671
Practice Address - Country:US
Practice Address - Phone:386-532-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11140310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142937000Medicaid