Rafael Avecillas

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11922 Issued in FL

Practice address

2644 Fritzke Rd
Dover, FL 33527-3433

Phone

(813) 325-9450

NPI assigned

Dec 11, 2013

Last updated

Dec 11, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Green Acres Assisted Living Corporation

  • Assisted Living Facility
  • Dover, FL
  • NPI 1063321404
  NPD (past) Authorized official

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1194156489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2644 FRITZKE RD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335273433",
            "telephone_number": "813-325-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2644 FRITZKE RD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335273433",
            "telephone_number": "813-325-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVECILLAS",
        "first_name": "RAFAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Algep
• Brianna Lee Ballard
• Barefoot Birth
• Kathleen Louise Barlow, DMD
• Charla Barron
• Yessica Bueno, RCSWI

• Assisted Living Facility in Dover, FL
• Providers in Dover, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.