Provider Demographics
NPI:1285066134
Name:LEISURE LAND ALF INC
Entity type:Organization
Organization Name:LEISURE LAND ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-702-4984
Mailing Address - Street 1:2301 NE 12TH TER
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5518
Mailing Address - Country:US
Mailing Address - Phone:754-300-8895
Mailing Address - Fax:
Practice Address - Street 1:2301 NE 12TH TER
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5518
Practice Address - Country:US
Practice Address - Phone:754-300-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12330310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility