Provider Demographics
NPI:1649615915
Name:ASSOCIATES IN ASSISTED LIVING INC.
Entity type:Organization
Organization Name:ASSOCIATES IN ASSISTED LIVING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-261-9494
Mailing Address - Street 1:1550 NECTARINE ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3030
Mailing Address - Country:US
Mailing Address - Phone:904-261-9494
Mailing Address - Fax:904-261-8383
Practice Address - Street 1:1550 NECTARINE ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3030
Practice Address - Country:US
Practice Address - Phone:904-261-9494
Practice Address - Fax:904-261-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9091310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678591300Medicaid