Healthcare Provider Details

I. General information

NPI: 1114334620
Provider Name (Legal Business Name): HERNANDEZ ALF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6604 N ORLEANS AVE
TAMPA FL
33604-6428
US

IV. Provider business mailing address

6604 N ORLEANS AVE
TAMPA FL
33604-6428
US

V. Phone/Fax

Practice location:
  • Phone: 813-270-6040
  • Fax:
Mailing address:
  • Phone: 813-270-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11339
License Number StateFL

VIII. Authorized Official

Name: MS. LISANDRA HERNANDEZ HERNANDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-270-6040