Provider Demographics
NPI:1194076695
Name:WINNIFRED ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:WINNIFRED ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAVINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-821-4699
Mailing Address - Street 1:1302 GINZA RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7918
Mailing Address - Country:US
Mailing Address - Phone:321-821-4699
Mailing Address - Fax:321-821-4699
Practice Address - Street 1:1302 GINZA RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7918
Practice Address - Country:US
Practice Address - Phone:321-821-4699
Practice Address - Fax:321-821-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11950310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility