Provider Demographics
NPI:1104268069
Name:BROXTON A.L.F. HOME
Entity type:Organization
Organization Name:BROXTON A.L.F. HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-548-5232
Mailing Address - Street 1:2233 PATE POND RD
Mailing Address - Street 2:
Mailing Address - City:CARYVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32427-2726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2233 PATE POND RD
Practice Address - Street 2:
Practice Address - City:CARYVILLE
Practice Address - State:FL
Practice Address - Zip Code:32427-2726
Practice Address - Country:US
Practice Address - Phone:850-548-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5856310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility