Provider Demographics
NPI:1881936953
Name:CEEMAR ASSISTED LIVING FACILITY LLC
Entity type:Organization
Organization Name:CEEMAR ASSISTED LIVING FACILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-241-4161
Mailing Address - Street 1:4665 HIDDEN LAKES PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7749
Mailing Address - Country:US
Mailing Address - Phone:321-241-4161
Mailing Address - Fax:321-241-4161
Practice Address - Street 1:4665 HIDDEN LAKES PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7749
Practice Address - Country:US
Practice Address - Phone:321-241-4161
Practice Address - Fax:321-241-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12208310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility