Active Senior Living Residence, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

9969 Issued in FL

Legal business name

ACTIVE SENIOR LIVING RESIDENCE, INC.

Practice address

9057 NW 57TH St
Tamarac, FL 33351-4305

Phone

(954) 721-1115

Fax

(954) 721-4397

NPI assigned

Dec 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Beth Ilona Tokarz

Title

Administrator

Phone

(954) 721-1115

Specialties & licenses 1

Addresses

Tax ID family

Active Senior Living Residence2 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.

• Active Senior Living Residence

  • Assisted Living Facility
  • Tamarac, FL
  • NPI 1417371857
  NPD tax ID

Locations

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861557464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9057 NW 57TH ST",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333514305",
            "telephone_number": "954-721-1115",
            "fax_number": "954-721-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9057 NW 57TH ST",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333514305",
            "telephone_number": "954-721-1115",
            "fax_number": "954-721-4397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE SENIOR LIVING RESIDENCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TOKARZ",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ILONA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-721-1115",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "9969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Absolute Support and Companion Services, LLC
• Acclaim Home Care Services, Inc. (none)
• Action Physical Therapy, LLC
• Action Physical Therapy, LLC
• Active Senior Living Residence
• Active Serenity
• Aliya Adams, DDS
• Minnette Adderly
• Addiction and Recovery Solution,LLC
• Joshua Addington, BCBA

• Assisted Living Facility in Tamarac, FL
• Providers in Tamarac, 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 Aug 22, 2020; 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.