Provider Profile
GOOD SAMARITAN CARE CENTER ASSISTED LIVING FACILITY INC.
Assisted Living Facility
FACILITY PROFILE
Street Address
- 6 RESTON PLACE
PALM COAST, FL 32164
County: Flagler - Phone: (386) 437-6244
Mailing Address
- 11 RESTON PLACE
PALM COAST, FL 32164
County: Flagler - Phone: (386) 793-6307
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility | ||||||
| Administrator: | DOROTA KOSZYK WIELGUS | ||||||
| Financial Officer: | DOROTA KOSZYK WIELGUS | ||||||
| Owner/Licensee: | GOOD SAMARITAN CARE CENTER ASSISTED LIVING FACILITY INC | ||||||
| Owner/Licensee Since: | 6/30/2005 | ||||||
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| Profit Status: | For-Profit | ||||||
| Management Company: | Not Available | ||||||
| Manager Since: | Not Available | ||||||
| Licensed Beds: | 6 | ||||||
| Bed Types: | Extended Congregate Care: 0 Private: 6 Optional State Supplement: 0 Total Capacity: 6 | ||||||
| AHCA Number (File Number): | 11966134 | ||||||
| AHCA Field Office: | 04 | ||||||
| License Number: | 10381 | ||||||
| Current License Effective: | 2/2/2022 | ||||||
| Current License Expires: | 2/1/2024 | ||||||
| License Status: | IN REVIEW | ||||||
Services/Characteristics
| Medicaid Services: | Assisted Living Waiver |
| Activities: | Arts and CraftsCooking ClassesDancingExercise ClassesGames/CardsGardeningShoppingSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | EnglishRussian |
| Nurse Availability: | 3rd Party 24hrDirect 24hr |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidVA |
| Special Programs and Services: | Memory CarePet Therapy |
| Community Residential Home | Yes |
Please be advised that local zoning authorities may have additional restrictions or requirements not under the jurisdiction of the Agency for Health Care Administration. Contact your local zoning authorities for any specific requirements. See also 419.001 F.S.
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Portable Generator |
| Emergency Power Supports: | Air ConditioningLife Safety SystemsLightsRefrigeration |
| Plan Approval: | 11/9/2017 |
| Implementation Date: | 11/9/2017 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Entire Facility |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 2400 |
| Number of People to use Cooled Space: | 8 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.