Healthcare Provider Details

I. General information

NPI: 1104242619
Provider Name (Legal Business Name): TORIA'S ASSISTED LIVING FACILITY 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 FOREST HILLS DR
BRANDON FL
33510-3825
US

IV. Provider business mailing address

PO BOX 6457
BRANDON FL
33508-6007
US

V. Phone/Fax

Practice location:
  • Phone: 813-361-9328
  • Fax: 813-621-9033
Mailing address:
  • Phone: 813-361-9328
  • Fax: 813-621-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ROWE
Title or Position: OWNER
Credential:
Phone: 813-361-9328