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General NPI Number Information
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NPI Number | 1083124622
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Entity Type | Organization
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Legal Business Name | CASITA MARIA ALF SERVICES
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 7744 HINSDALE DR
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City | TAMPA
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State | FL
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Zip | 33615-1504
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Country | US
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Telephone | 813-471-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 7744 HINSDALE DR
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City | TAMPA
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State | FL
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Zip | 33615-1504
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Country | US
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Telephone | 813-895-8812
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Fax |
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Authorized Official
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Title or Position | ALF ADMINISTRATOR
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Name | MR. JOSE EMMANUEL GOMEZ
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Credential |
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Telephone | 813-895-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALI3077
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License Number State | FL
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