Healthcare Provider Details

I. General information

NPI: 1427683226
Provider Name (Legal Business Name): ABUELO FELIZ HOME 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 W JEAN ST
TAMPA FL
33614-3610
US

IV. Provider business mailing address

4535 W JEAN ST
TAMPA FL
33614-3610
US

V. Phone/Fax

Practice location:
  • Phone: 813-495-3660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CARLOS M DE ARMAS
Title or Position: OWNER
Credential:
Phone: 813-495-3660