Provider Demographics
NPI:1194484162
Name:A & C LIVING FAITH HOME LLC
Entity type:Organization
Organization Name:A & C LIVING FAITH HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-557-7219
Mailing Address - Street 1:578 FELLENZ ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-4780
Mailing Address - Country:US
Mailing Address - Phone:786-501-0387
Mailing Address - Fax:321-241-2972
Practice Address - Street 1:578 FELLENZ ST SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-4780
Practice Address - Country:US
Practice Address - Phone:321-557-7219
Practice Address - Fax:321-241-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility