Provider Demographics
NPI:1932561107
Name:CARMITA'S ASSISTING LIVING FACILITY IV LLC
Entity Type:Organization
Organization Name:CARMITA'S ASSISTING LIVING FACILITY IV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-432-6785
Mailing Address - Street 1:1103 MARSCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1984
Mailing Address - Country:US
Mailing Address - Phone:407-432-6785
Mailing Address - Fax:321-245-7895
Practice Address - Street 1:1103 MARSCASTLE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-1984
Practice Address - Country:US
Practice Address - Phone:407-432-6785
Practice Address - Fax:321-245-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12807310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility