Provider Demographics
NPI:1871835165
Name:LA CASA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LA CASA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:KRODEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-449-8880
Mailing Address - Street 1:220 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3444
Mailing Address - Country:US
Mailing Address - Phone:321-449-8880
Mailing Address - Fax:321-806-4500
Practice Address - Street 1:220 N GROVE ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3444
Practice Address - Country:US
Practice Address - Phone:321-449-8880
Practice Address - Fax:321-806-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11568310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility