Provider Demographics
NPI:1003570334
Name:JC & C ALF LLC
Entity type:Organization
Organization Name:JC & C ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OIWNER
Authorized Official - Prefix:
Authorized Official - First Name:EYLIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-281-1583
Mailing Address - Street 1:158 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4007
Mailing Address - Country:US
Mailing Address - Phone:786-600-8679
Mailing Address - Fax:786-600-8679
Practice Address - Street 1:158 W 10TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4007
Practice Address - Country:US
Practice Address - Phone:786-600-8679
Practice Address - Fax:786-600-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003908000Medicaid