A & C Living Faith Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

A & C LIVING FAITH HOME LLC

Practice address

578 Fellenz St SW
Palm Bay, FL 32908-4780

Phone

(321) 557-7219

Fax

(321) 241-2972

NPI assigned

Dec 16, 2021

Organization subpart

No

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

Authorized official

Name

Carline Louis Jean

Title

Owner/Administrator

Phone

(321) 557-7219

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639612800000",
    "number": "1194484162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "578 FELLENZ ST SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329084780",
            "telephone_number": "786-501-0387",
            "fax_number": "321-241-2972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "578 FELLENZ ST SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329084780",
            "telephone_number": "321-557-7219",
            "fax_number": "321-241-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A & C LIVING FAITH HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "LOUIS JEAN",
        "authorized_official_first_name": "CARLINE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "321-557-7219"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.