Provider Demographics
NPI:1982097572
Name:ALANSON ACRES ACTIVE SENIOR LIVING LLC.
Entity type:Organization
Organization Name:ALANSON ACRES ACTIVE SENIOR LIVING LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CLARK-MOREFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-873-7407
Mailing Address - Street 1:1644 ALANSON DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7907
Mailing Address - Country:US
Mailing Address - Phone:386-873-7407
Mailing Address - Fax:
Practice Address - Street 1:1644 ALANSON DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7907
Practice Address - Country:US
Practice Address - Phone:386-873-7407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906736311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home