Provider Demographics
NPI:1255752911
Name:CLERMONT ALF INVESTORS, LLC
Entity type:Organization
Organization Name:CLERMONT ALF INVESTORS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-686-3831
Mailing Address - Street 1:1600 HUNT TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5184
Mailing Address - Country:US
Mailing Address - Phone:352-394-5549
Mailing Address - Fax:
Practice Address - Street 1:1600 HUNT TRACE BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5184
Practice Address - Country:US
Practice Address - Phone:352-394-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERIOR RESIDENCES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10160310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10160OtherAHCA