Provider Demographics
NPI:1619306164
Name:GREENLEAF ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:GREENLEAF ASSISTED LIVING LLC
Other - Org Name:ALL SEASONS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-731-8312
Mailing Address - Street 1:509 VERONA ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5114
Mailing Address - Country:US
Mailing Address - Phone:407-931-3995
Mailing Address - Fax:407-931-2722
Practice Address - Street 1:509 VERONA ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5114
Practice Address - Country:US
Practice Address - Phone:407-931-3995
Practice Address - Fax:407-931-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility