Healthcare Provider Details

I. General information

NPI: 1801212097
Provider Name (Legal Business Name): FAITH HOME CARE ALF INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 EUCLID AVE
SEFFNER FL
33584-8000
US

IV. Provider business mailing address

114 EUCLID AVE
SEFFNER FL
33584-8000
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-1922
  • Fax: 813-689-1900
Mailing address:
  • Phone: 813-689-1922
  • Fax: 813-689-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12447
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSALYN YVETTE GREEN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 813-689-1922