Provider Demographics
NPI:1548896343
Name:LAS VILLAS ALF LLC
Entity type:Organization
Organization Name:LAS VILLAS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:392-673-7202
Mailing Address - Street 1:754 FESTIVAL AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-0736
Mailing Address - Country:US
Mailing Address - Phone:239-369-0631
Mailing Address - Fax:239-673-7202
Practice Address - Street 1:754 FESTIVAL AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-0736
Practice Address - Country:US
Practice Address - Phone:239-369-0631
Practice Address - Fax:239-673-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13424OtherAHCA