MEDICARE: THE ABUELO'S QUIET VILLAGE ALF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	12938	FL

General Provider Information

NPI Number	:	1669903704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ABUELO'S QUIET VILLAGE ALF

Provider Business Mailing Address
First Line	:	2307 W SAINT JOSEPH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1651
Country	:	US
Telephone Number	:	813-468-4890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 W SAINT JOSEPH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1651
Country	:	US
Telephone Number	:	813-468-4890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PEDRO A VELAZQUEZ
Credential	:
Telephone Number	:	813-468-4890

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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Directions to “THE ABUELO'S QUIET VILLAGE ALF ” Practice Location

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