Provider Demographics
NPI:1922315514
Name:EMMANUEL ADULT ALF, INC
Entity Type:Organization
Organization Name:EMMANUEL ADULT ALF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARRERO RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-815-7771
Mailing Address - Street 1:14950 LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2741
Mailing Address - Country:US
Mailing Address - Phone:305-242-4671
Mailing Address - Fax:
Practice Address - Street 1:14950 LEISURE DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2741
Practice Address - Country:US
Practice Address - Phone:305-242-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11802310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility