Provider Demographics
NPI:1619354768
Name:PARKVIEW ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:PARKVIEW ASSISTED LIVING FACILITY, LLC
Other - Org Name:PARKVIEW ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:DEPOSOY
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-747-2109
Mailing Address - Street 1:735 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4076
Mailing Address - Country:US
Mailing Address - Phone:386-738-4078
Mailing Address - Fax:386-734-7001
Practice Address - Street 1:735 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4076
Practice Address - Country:US
Practice Address - Phone:386-738-4078
Practice Address - Fax:386-734-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10665310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility