Provider Demographics
NPI:1487182804
Name:ALTON ACLF HOME
Entity type:Organization
Organization Name:ALTON ACLF HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:0WNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:LATTERY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-687-7142
Mailing Address - Street 1:2090 NW 115TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-2710
Mailing Address - Country:US
Mailing Address - Phone:305-687-7142
Mailing Address - Fax:305-687-7142
Practice Address - Street 1:2090 NW 115TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-2710
Practice Address - Country:US
Practice Address - Phone:305-687-7142
Practice Address - Fax:305-687-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8582310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility