Provider Demographics
NPI:1053739920
Name:LORRAINE ASSISTED CARE, INC
Entity type:Organization
Organization Name:LORRAINE ASSISTED CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BONGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-504-9412
Mailing Address - Street 1:5916 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9208
Mailing Address - Country:US
Mailing Address - Phone:941-504-9412
Mailing Address - Fax:941-761-5200
Practice Address - Street 1:5916 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9208
Practice Address - Country:US
Practice Address - Phone:941-504-9412
Practice Address - Fax:941-761-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12366261QA0600X, 310400000X, 311ZA0620X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004043700Medicaid