Provider Demographics
NPI:1063925444
Name:SAEJCA'S CASTLE LLC II
Entity type:Organization
Organization Name:SAEJCA'S CASTLE LLC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:LAURE
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-7098
Mailing Address - Street 1:1340 NE 179TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1316
Mailing Address - Country:US
Mailing Address - Phone:786-399-7098
Mailing Address - Fax:786-657-2955
Practice Address - Street 1:761 NW 203RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2302
Practice Address - Country:US
Practice Address - Phone:305-974-4511
Practice Address - Fax:786-657-2955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAEJCA'S CASTLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL130463104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness