Organization
FLORIDA ASSISTANT LIVING ORGANIZATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE M. PEACOCK (ADMINISTRATOR)
(850) 973-2380
Entity
Organization
Contact information
Practice address
585 SE LAKESHORE DR, MADISON, FL 32340-2734
(850) 973-2415
Mailing address
219 SE ABERNATHY WAY, MADISON, FL 32340-7044
(850) 973-2415
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11916
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003217200
—
FL
Enumeration date
05/06/2014
Last updated
05/06/2014
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