Healthcare Provider Details

I. General information

NPI: 1184396871
Provider Name (Legal Business Name): AMERICAN DREAM ALF , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 04/03/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 W KNOLLWOOD ST
TAMPA FL
33614-3636
US

IV. Provider business mailing address

4532 W KNOLLWOOD ST
TAMPA FL
33614-3636
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-8801
  • Fax: 813-280-9418
Mailing address:
  • Phone: 786-419-8801
  • Fax: 813-280-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RUBEIDY PEREZ GARCIA
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-419-8801