Lilac House LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11050 Issued in FL

Legal business name

LILAC HOUSE LLC

Practice address

1770 S Lilac Cir
Titusville, FL 32796-3274

Phone

(321) 626-6672

NPI assigned

Mar 29, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Amber Brooks

Title

Manager

Phone

(321) 458-8327

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1902149883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 S LILAC CIR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963274",
            "telephone_number": "321-626-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 S LILAC CIR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963274",
            "telephone_number": "321-626-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILAC HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-458-8327",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11050",
            "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 Aug 29, 2022; 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.