Provider Demographics
NPI:1356572192
Name:JBS ASSISTED LIVING HOME INC
Entity type:Organization
Organization Name:JBS ASSISTED LIVING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINASTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-369-8282
Mailing Address - Street 1:1517 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-5410
Mailing Address - Country:US
Mailing Address - Phone:954-369-8282
Mailing Address - Fax:
Practice Address - Street 1:1511 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-5410
Practice Address - Country:US
Practice Address - Phone:954-990-4847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11448310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11448OtherASSISTED LIVING