Organization
HOUSE OF LIGHT SENIOR LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIVIENE CORNETTA MOORE (ADMINISTRATOR)
(321) 368-5611
Entity
Organization
Contact information
Practice address
2638 JUPITER BLVD SW, PALM BAY, FL 32908-3565
(321) 368-5611
(321) 345-5925
Mailing address
2638 JUPITER BLVD SW, PALM BAY, FL 32908-3565
(321) 368-5611
(321) 345-5925
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12240
FL
Other
Enumeration date
08/31/2012
Last updated
02/03/2013
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