Provider Demographics
NPI:1629258678
Name:ALTERNATIVE SENIOR CARE
Entity Type:Organization
Organization Name:ALTERNATIVE SENIOR CARE
Other - Org Name:THE HERITAGE AT LAKE FOREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-322-2207
Mailing Address - Street 1:5433 SR 46
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9236
Mailing Address - Country:US
Mailing Address - Phone:407-322-2207
Mailing Address - Fax:407-302-3411
Practice Address - Street 1:5433 SR 46
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9236
Practice Address - Country:US
Practice Address - Phone:407-322-2207
Practice Address - Fax:407-302-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10233310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility