Provider Demographics
NPI:1013169887
Name:FLORIDA SHORES ASSISTED LIVING FACILITY INC.
Entity Type:Organization
Organization Name:FLORIDA SHORES ASSISTED LIVING FACILITY INC.
Other - Org Name:FLORIDA SHORES OF MELBOURNE 2 ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISABELO
Authorized Official - Middle Name:
Authorized Official - Last Name:NUDALO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-428-5370
Mailing Address - Street 1:4060 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6212
Mailing Address - Country:US
Mailing Address - Phone:386-428-5370
Mailing Address - Fax:386-428-5370
Practice Address - Street 1:4060 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6212
Practice Address - Country:US
Practice Address - Phone:386-428-5370
Practice Address - Fax:386-428-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8089310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility