Provider Demographics
NPI:1922419977
Name:ASHLEY MANOR ALF
Entity Type:Organization
Organization Name:ASHLEY MANOR ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANCASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR/OWNER
Authorized Official - Phone:786-346-4683
Mailing Address - Street 1:3815 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1951
Mailing Address - Country:US
Mailing Address - Phone:561-495-1848
Mailing Address - Fax:561-495-1848
Practice Address - Street 1:3815 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-1951
Practice Address - Country:US
Practice Address - Phone:561-495-1848
Practice Address - Fax:561-495-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL#11968609310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL#11968609OtherASSISTED LIVING FACILITY