Provider Demographics
NPI:1194942615
Name:CENTURY ASSISTED LIVING FACILITY, INC.
Entity type:Organization
Organization Name:CENTURY ASSISTED LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-642-1375
Mailing Address - Street 1:15900 S.W. 72 TERR.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193
Mailing Address - Country:US
Mailing Address - Phone:305-752-3064
Mailing Address - Fax:786-551-2660
Practice Address - Street 1:15900 S.W. 72 TERR.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193
Practice Address - Country:US
Practice Address - Phone:305-752-3064
Practice Address - Fax:786-551-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10129310400000X
FLAL10913310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141693600OtherMEDICAID OSS PROVIDER
FL689043100OtherMEDICAID WAIVER PROVIDER