Provider Demographics
NPI:1932523578
Name:MISTY MEADOWS ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:MISTY MEADOWS ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-472-2820
Mailing Address - Street 1:103 NW 298TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2635
Mailing Address - Country:US
Mailing Address - Phone:352-472-2820
Mailing Address - Fax:352-472-0294
Practice Address - Street 1:103 NW 298TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2635
Practice Address - Country:US
Practice Address - Phone:352-472-2820
Practice Address - Fax:352-472-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8031310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility