Provider Demographics
NPI:1902149024
Name:TYVAL ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:TYVAL ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALRIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-752-0172
Mailing Address - Street 1:3526 GENEVRA AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3103
Mailing Address - Country:US
Mailing Address - Phone:561-364-4772
Mailing Address - Fax:561-369-1449
Practice Address - Street 1:3526 GENEVRA AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3103
Practice Address - Country:US
Practice Address - Phone:561-364-4772
Practice Address - Fax:561-369-1449
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
FLAL11128310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility