MEDICARE: A1A LARIMER GROUP HOME LLC

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1871247635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1A LARIMER GROUP HOME LLC

Provider Business Mailing Address
First Line	:	7105 LARIMER CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2950
Country	:	US
Telephone Number	:	305-803-9960
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 LARIMER CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2950
Country	:	US
Telephone Number	:	305-803-9960
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARIA AMELIA CARRALERO
Credential	:
Telephone Number	:	305-803-9960

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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