Provider Demographics
NPI:1730847955
Name:FUTURE SMILES SENIOR LIVING, LLC
Entity type:Organization
Organization Name:FUTURE SMILES SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAS
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTING
Authorized Official - Phone:772-300-6670
Mailing Address - Street 1:4645 SW VAHALLA STREET
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953
Mailing Address - Country:US
Mailing Address - Phone:772-878-5547
Mailing Address - Fax:
Practice Address - Street 1:4645 SW VAHALLA STREET
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:772-878-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115155700Medicaid