Provider Demographics
NPI:1619603073
Name:UNIQUE ASSISTED LIVING
Entity Type:Organization
Organization Name:UNIQUE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-514-7890
Mailing Address - Street 1:8501 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2905
Mailing Address - Country:US
Mailing Address - Phone:954-575-8585
Mailing Address - Fax:
Practice Address - Street 1:8501 NW 38TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2905
Practice Address - Country:US
Practice Address - Phone:954-575-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114145500Medicaid