Provider Demographics
NPI:1285136275
Name:ASSURED CARE ALF
Entity type:Organization
Organization Name:ASSURED CARE ALF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-239-7558
Mailing Address - Street 1:10004 COUNTRY CARRIAGE CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5694
Mailing Address - Country:US
Mailing Address - Phone:813-239-7558
Mailing Address - Fax:
Practice Address - Street 1:2006 WRANGLER DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2121
Practice Address - Country:US
Practice Address - Phone:813-239-7558
Practice Address - Fax:813-571-9909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSURED CARE ALF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13136310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014144700Medicaid