Provider Demographics
NPI:1912451980
Name:EXCELLENCE ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:EXCELLENCE ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIGLIATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-930-9290
Mailing Address - Street 1:5950 LAKEHURST DR STE 182
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8363
Mailing Address - Country:US
Mailing Address - Phone:407-930-9290
Mailing Address - Fax:407-930-9380
Practice Address - Street 1:2250 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2704
Practice Address - Country:US
Practice Address - Phone:407-930-9291
Practice Address - Fax:407-930-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12850310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility