Provider Demographics
NPI:1922396431
Name:KINDHEARTED ASSISTED LIVING FACILITY, INC.
Entity Type:Organization
Organization Name:KINDHEARTED ASSISTED LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-578-5800
Mailing Address - Street 1:2815 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4107
Mailing Address - Country:US
Mailing Address - Phone:863-178-4800
Mailing Address - Fax:863-578-3017
Practice Address - Street 1:2815 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4107
Practice Address - Country:US
Practice Address - Phone:863-248-3038
Practice Address - Fax:863-578-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11530310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000881700Medicaid