Provider Demographics
NPI:1437492519
Name:STILLWATER ALF INC.
Entity type:Organization
Organization Name:STILLWATER ALF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:321-684-3691
Mailing Address - Street 1:2881 QUENTIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-9225
Mailing Address - Country:US
Mailing Address - Phone:321-914-3688
Mailing Address - Fax:321-914-3689
Practice Address - Street 1:2881 QUENTIN AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-9225
Practice Address - Country:US
Practice Address - Phone:321-914-3688
Practice Address - Fax:321-914-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10861310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility