Organization
GRAND FORTUNE GROUP
Active
Other names
Amber Lake Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN BARTOLO (CFO)
(407) 348-6100
Entity
Organization
Contact information
Practice address
2411 FORTUNE RD, KISSIMMEE, FL 34744-3964
(407) 348-6100
(407) 348-0031
Mailing address
2411 FORTUNE RD, KISSIMMEE, FL 34744-3964
(407) 348-6100
(407) 348-0031
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7215
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140952200
—
FL
Enumeration date
02/17/2011
Last updated
02/17/2011
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