Provider Demographics
NPI:1265723456
Name:PERSONAL TOUCH ASSISTED LIVING FACILITY INC
Entity type:Organization
Organization Name:PERSONAL TOUCH ASSISTED LIVING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQULINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-484-9533
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478
Mailing Address - Country:US
Mailing Address - Phone:352-292-3244
Mailing Address - Fax:
Practice Address - Street 1:20 FIR TRAIL COURSE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472
Practice Address - Country:US
Practice Address - Phone:352-292-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11730385H00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001667200Medicaid