Provider Demographics
NPI:1710385398
Name:SHANGRI-LA OF MELBOURNE ALF LLC
Entity Type:Organization
Organization Name:SHANGRI-LA OF MELBOURNE ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LAPOINTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-507-8722
Mailing Address - Street 1:2204 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5234
Mailing Address - Country:US
Mailing Address - Phone:321-507-8722
Mailing Address - Fax:321-473-8703
Practice Address - Street 1:2204 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5234
Practice Address - Country:US
Practice Address - Phone:321-507-8722
Practice Address - Fax:321-473-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11162310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility