Provider Demographics
NPI:1578136602
Name:YOU'RE AT HOME ALF, INC.
Entity type:Organization
Organization Name:YOU'RE AT HOME ALF, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REPOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-217-7018
Mailing Address - Street 1:901 N HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6708
Mailing Address - Country:US
Mailing Address - Phone:407-523-3000
Mailing Address - Fax:407-523-3008
Practice Address - Street 1:901 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6708
Practice Address - Country:US
Practice Address - Phone:407-523-3000
Practice Address - Fax:407-523-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111090400Medicaid