Provider Demographics
NPI:1396902193
Name:SUUNY DAYS ALF,INC
Entity type:Organization
Organization Name:SUUNY DAYS ALF,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POWERS SALVATO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-285-2466
Mailing Address - Street 1:169 NE PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8462
Mailing Address - Country:US
Mailing Address - Phone:772-343-9088
Mailing Address - Fax:772-343-9074
Practice Address - Street 1:169 NE PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8462
Practice Address - Country:US
Practice Address - Phone:772-343-9088
Practice Address - Fax:772-343-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9008310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility