Provider Demographics
NPI:1710229976
Name:FLORIDA SHORES OF MELBOURNE ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:FLORIDA SHORES OF MELBOURNE ASSISTED LIVING INC.
Other - Org Name:FLORIDA SHORES OF MELBOURNE 1 ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-541-5552
Mailing Address - Street 1:2155 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6146
Mailing Address - Country:US
Mailing Address - Phone:646-541-5552
Mailing Address - Fax:321-951-0896
Practice Address - Street 1:2155 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6146
Practice Address - Country:US
Practice Address - Phone:646-541-5552
Practice Address - Fax:321-951-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7324310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility