Organization
SPACE COAST ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE M AUGUSTE (OWNER)
(561) 503-3719
Entity
Organization
Contact information
Practice address
1832 COUNTRY CLUB DR, TITUSVILLE, FL 32780-5346
(321) 567-4191
(888) 335-7714
Mailing address
1832 COUNTRY CLUB DR, TITUSVILLE, FL 32780-5346
(321) 567-4191
(888) 335-7714
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10800
AHCA
FL
Enumeration date
10/18/2021
Last updated
10/18/2021
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