Provider Demographics
NPI:1306189014
Name:A.L.F. AT OCEAN BREEZE GARDENS
Entity type:Organization
Organization Name:A.L.F. AT OCEAN BREEZE GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KALEI
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKSTILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-591-4113
Mailing Address - Street 1:PO BOX 372068
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-0068
Mailing Address - Country:US
Mailing Address - Phone:321-610-7056
Mailing Address - Fax:321-989-0207
Practice Address - Street 1:535 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2929
Practice Address - Country:US
Practice Address - Phone:321-610-7056
Practice Address - Fax:321-989-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11569310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility