Organization
FAIRGREEN ASSISTED LIVING INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESUSA H. KEPLER R.N. (OWNER/ADMINISTRATOR)
(386) 428-3018
Entity
Organization
Contact information
Practice address
1150 WAYNE AVE., NEW SMYRNA BEACH, FL 32168
(386) 428-3018
(386) 428-7485
Mailing address
1150 WAYNE AVE, NEW SMYRNA BEACH, FL 32168-6132
(386) 428-3018
(386) 428-7485
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1150
—
FL
Enumeration date
09/13/2013
Last updated
09/13/2013
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