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Nic 4 Southern Gardens Leasing Llc
Assisted Living Facility in Lake Alfred, Florida
NPI 1710321112

Nic 4 Southern Gardens Leasing Llc is an Assisted Living Facility based in Lake Alfred, FL. Nic 4 Southern Gardens Leasing Llc practices in Lake Alfred, FL. The NPI Number for Nic 4 Southern Gardens Leasing Llc is 1710321112 and holds a License No. 8937 (Florida).

The current practice location address for Nic 4 Southern Gardens Leasing Llc is 255 E Main St, Lake Alfred, FL and can be reached out via phone at 212-479-5343.

Location: 255 E Main St, Lake Alfred, FL, 33850-2133
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1710321112
Provider Name
Nic 4 Southern Gardens Leasing Llc
Credential
Provider Entity Type
Organization
Address
255 E Main St, Lake Alfred, FL, 33850-2133
Phone Number
212-479-5343
Fax Number
Provider Enumeration Date
04/29/2013
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
689986200 01 FL MEDICAID AL WAIVER
1423860 01 FL MEDICAID ACS
institution
Provider Business Practice Location Address Details
Address
255 E Main St
City
Lake Alfred
State
Florida
Zip
33850-2133
Phone Number
212-479-5343
Fax Number
person
Provider Business Mailing Address Details
Address
255 E Main St
City
Lake Alfred
State
Florida
Zip
33850-2133
Phone Number
212-479-5343
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Assisted Living Facility
Speciality
-
Taxonomy
310400000X
License No.
8937 (Florida)
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
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