Provider Profile
SPACE COAST ASSISTED LIVING LLC
Assisted Living Facility
FACILITY PROFILE
Street Address
- 1832 COUNTRY CLUB DRIVE
TITUSVILLE, FL 32780
County: Brevard - Phone: (321) 383-3531
Mailing Address
- 1832 COUNTRY CLUB DRIVE
TITUSVILLE, FL 32780
County: Brevard - Phone: (321) 567-4191
AHCA Reports
Inspection ReportsInspection Details
Consumer Guides
Assisted Living in FloridaLong-Term Care
Patient Safety
Health Care Advance Directives
Facility Information:
| Facility/Provider Type: | Assisted Living Facility | |||||||||
| Administrator: | MUDELLE LOUIS | |||||||||
| Financial Officer: | MARIE M AUGUSTE | |||||||||
| Owner/Licensee: | SPACE COAST ASSISTED LIVING LLC | |||||||||
| Owner/Licensee Since: | 10/12/2021 | |||||||||
| ||||||||||
| Profit Status: | For-Profit | |||||||||
| Management Company: | Not Available | |||||||||
| Manager Since: | Not Available | |||||||||
| Licensed Beds: | 8 | |||||||||
| Bed Types: | Extended Congregate Care: 0 Private: 5 Total Capacity: 8 Optional State Supplement: 3 | |||||||||
| AHCA Number (File Number): | 11966628 | |||||||||
| AHCA Field Office: | 07 | |||||||||
| License Number: | 10800 | |||||||||
| Current License Effective: | 10/12/2023 | |||||||||
| Current License Expires: | 10/11/2025 | |||||||||
| License Status: | LICENSED | |||||||||
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Specialty License: | Limited Mental Health |
| Activities: | Arts and CraftsExercise ClassesGames/CardsGardeningMusic ProgramsSocial 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: | English |
| Nurse Availability: | None |
| 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: | Fixed Generator |
| Emergency Power Supports: | Entire Facility |
| Plan Approval: | 12/11/2018 |
| Implementation Date: | 12/20/2017 |
| Implementation Extended Until: | 1/1/2019 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Entire Facility |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 1968 |
| Number of People to use Cooled Space: | 8 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 4/5/2022 | 2022005205 | Fine | Survey | $500.00 | 6/20/2022 |
| Change of ownership occurred 10/12/2021 | |||||
| 7/12/2019 | 2019010815 | Denied | Application | $0.00 | 9/16/2019 |
| 8/2/2018 | 2018011364 | Fine | Licensure | $500.00 | 10/23/2018 |
| Change of ownership occurred 1/17/2013 | |||||
| 12/3/2010 | 2010013506 | Fine | Survey | $1,236.00 | 3/28/2011 |
| 3/7/2008 | 2008003780 | Fine | Survey | $1,000.00 | 5/22/2008 |
| 6/29/2006 | 2006006320 | Fine | Survey | $2,500.00 | 5/11/2007 |
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.