Provider Demographics
NPI:1851173413
Name:CROWN ASSISTED LIVING
Entity Type:Organization
Organization Name:CROWN ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YVENET
Authorized Official - Middle Name:
Authorized Official - Last Name:JESUCA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-674-4554
Mailing Address - Street 1:8736 ESCONDIDO WAY E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-2669
Practice Address - Country:US
Practice Address - Phone:561-674-4554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility