Provider Demographics
NPI:1902355241
Name:ACTS ADULT LIVING FACILITES LLC
Entity type:Organization
Organization Name:ACTS ADULT LIVING FACILITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:MERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-208-9486
Mailing Address - Street 1:4715 SW 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5860
Mailing Address - Country:US
Mailing Address - Phone:305-853-6955
Mailing Address - Fax:305-853-6955
Practice Address - Street 1:4715 SW 95TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5860
Practice Address - Country:US
Practice Address - Phone:305-853-6955
Practice Address - Fax:305-853-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12843310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018337200Medicaid