Provider Demographics
NPI:1144973256
Name:ACACIA LIVING, LLC
Entity type:Organization
Organization Name:ACACIA LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-220-7435
Mailing Address - Street 1:7348 ASHLEY SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7614
Mailing Address - Country:US
Mailing Address - Phone:912-220-7435
Mailing Address - Fax:
Practice Address - Street 1:7348 ASHLEY SHORES CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7614
Practice Address - Country:US
Practice Address - Phone:912-220-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child