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Organization Active NPI

Florida Shores Assisted Living Facility Inc.

Doing business as Florida Shores of Melbourne 2 ALF

  • Assisted Living Facility
  • W Melbourne, FL
National Provider Identifier
1013169887
Registry record updated Oct 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL8089 Issued in FL
Legal business name
FLORIDA SHORES ASSISTED LIVING FACILITY INC.
Doing business as
Florida Shores of Melbourne 2 ALF
Practice address
4060 Miami Ave
W Melbourne, FL 32904-6212
Phone
(386) 428-5370
Fax
(386) 428-5370
NPI assigned
Oct 10, 2008
Last updated
Oct 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Isabelo Nudalo Jr.
Title
Owner / Administrator
Phone
(386) 428-5370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL8089 FL Primary

Addresses

Primary practice location

4060 Miami Ave
W Melbourne, FL 32904-6212

Mailing address

4060 Miami Ave
W Melbourne, FL 32904-6212
Phone (386) 428-5370

Other names 1

  • Florida Shores of Melbourne 2 ALF Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Florida Shores Assisted Living Facility Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1013169887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 MIAMI AVE",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329046212",
            "telephone_number": "386-428-5370",
            "fax_number": "386-428-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 MIAMI AVE",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329046212",
            "telephone_number": "386-428-5370",
            "fax_number": "386-428-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA SHORES ASSISTED LIVING FACILITY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-10",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "NUDALO",
        "authorized_official_first_name": "ISABELO",
        "authorized_official_title_or_position": "OWNER / ADMINISTRATOR",
        "authorized_official_telephone_number": "386-428-5370",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Shores of Melbourne 2 ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in W Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.