Provider Demographics
NPI:1982048294
Name:SAEJCA'S CASTLE LLC
Entity Type:Organization
Organization Name:SAEJCA'S CASTLE LLC
Other - Org Name:SAEJCA'S CASTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-7098
Mailing Address - Street 1:13393 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3911
Mailing Address - Country:US
Mailing Address - Phone:954-450-5506
Mailing Address - Fax:
Practice Address - Street 1:13393 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3911
Practice Address - Country:US
Practice Address - Phone:954-450-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11207310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility