Amazing Grace Assisted Living Home III LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

12836 Issued in FL

Legal business name

AMAZING GRACE ASSISTED LIVING HOME III LLC

Practice address

1851 Evergreen Dr
Lake Clarke Shores, FL 33406-5231

Phone

(561) 642-4221

NPI assigned

Jun 13, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Debbie Lytle

Title

Owner

Phone

(561) 818-5790

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528848000000",
    "number": "1356834311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 EVERGREEN DR",
            "city": "LAKE CLARKE SHORES",
            "state": "FL",
            "postal_code": "334065231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 EVERGREEN DR",
            "city": "LAKE CLARKE SHORES",
            "state": "FL",
            "postal_code": "334065231",
            "telephone_number": "561-642-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE ASSISTED LIVING HOME III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-13",
        "last_updated": "2018-06-13",
        "status": "A",
        "authorized_official_last_name": "LYTLE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-818-5790",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Lake Clarke Shores, FL
• Providers in Lake Clarke Shores, 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 Jun 13, 2018; 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.