Provider Demographics
NPI:1972741874
Name:THE ISLANDS ALF, INC.
Entity Type:Organization
Organization Name:THE ISLANDS ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENECIA
Authorized Official - Middle Name:BAGUHIN
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-523-3000
Mailing Address - Street 1:10635 VIA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3369
Mailing Address - Country:US
Mailing Address - Phone:407-678-6882
Mailing Address - Fax:
Practice Address - Street 1:901 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6708
Practice Address - Country:US
Practice Address - Phone:407-523-3000
Practice Address - Fax:407-523-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4690310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140439300Medicaid
FL683746800Medicaid
FL676064300Medicaid