Provider Demographics
NPI:1902389927
Name:ACTIVE CARE ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:ACTIVE CARE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:321-948-5569
Mailing Address - Street 1:2436 LAKE JACKSON CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5846
Mailing Address - Country:US
Mailing Address - Phone:321-948-5569
Mailing Address - Fax:
Practice Address - Street 1:2436 LAKE JACKSON CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5846
Practice Address - Country:US
Practice Address - Phone:321-948-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility