Provider Demographics
NPI:1275853228
Name:LONG LIFE CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:LONG LIFE CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-345-1422
Mailing Address - Street 1:9851 NW 53RD CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2636
Mailing Address - Country:US
Mailing Address - Phone:954-345-1422
Mailing Address - Fax:
Practice Address - Street 1:9851 NW 53RD CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2636
Practice Address - Country:US
Practice Address - Phone:954-345-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11562OtherACHA LICENSE #